Endoscopic treatment instrument

ABSTRACT

An endoscopic treatment instrument having a treatment portion having: an input member; a first link disconnectably connected to the input member; a first control plate disposed in a first connecting portion, inserting the input member through the first control plate, and engaging the input member by inclination of the first control plate; a first forceps member opening and closing according to advancing and retracting motions of the first link; a second link disconnectably connected to the input member; a second control plate disposed in a second connecting portion, inserting the input member through the second control plate, and engaging the input member by inclination of the second control plate; and a second forceps member opening and closing according to advancing and retracting motions of the second link, the opening-and-closing angle of the second forceps member being less than that of the first forceps member.

This is a Continuation-In-Part application that claims priority on U.S.patent application Ser. No. 11/331,962, filed Jan. 13, 2006, thecontents of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a treatment instrument for anendoscope, and more particularly, to a retaining device placed andretained in the interior of a human body and an applicator used toretain the retaining device therein.

2. Background Art

An abdominal operation in which a medical procedure is performed bylargely incising the abdominal wall, a laparoscopic surgery in which amedical procedure is performed by approaching the abdominal cavitiesthrough an incision formed in the abdominal wall, or an endoscopicprocedure in which a desired treatment is performed by inserting aflexible endoscope into the human body through the mouth or the anus isconventionally known as a method for performing a medical procedure thatdeals with, for example, internal organs of the human body.

In the medical procedures using these methods, bodily tissues aresutured, tightly bound, or ligated. A retaining device that is placedand retained in a human body is often used when such a treatment isperformed. This type of retaining device is attached to an applicator,and is retained in a desired region of the human body by operating theapplicator from the interior of the human body.

US Patent Application Publication No. 2003-0181924A1 discloses anexample of this type of retaining device and an applicator used toretain the retaining device (hereinafter, a “treatment instrument” isused as a general term for the retaining device and the applicator). Thetreatment instrument disclosed by this related art has the followingstructure. A detachable needle attached to a curved needle is insertedinto bodily tissues, and then a hook sheath is moved toward the distalend of the instrument. Thereafter, the detachable needle is engaged by acasing engaged with the distal end. The hook sheath is then pulledtoward the proximal end of the instrument, and the detachable needle isdetached from the curved needle.

SUMMARY OF THE INVENTION

It is an object of the present invention to provide an improvedendoscopic treatment instrument having higher operability.

The endoscopic treatment instrument according to a first aspect of thepresent invention includes an insertion portion having a distal end anda proximal end, the distal end being inserted into a human body; atreatment portion provided at the distal end of the insertion portion;and a control portion provided at the proximal end of the insertionportion, and the treatment portion includes a pair of forceps members; atip cover which supports a pivot shaft that pivots at least one of thepair of forceps members openably and closably with respect to the otherforceps member; a distal end holding portion that is fixed to the distalend of the insertion portion and in which the tip cover is heldrelatively movably toward the distal end of the insertion portion andtoward the proximal end of the insertion portion; a distal end lockingmember that restrains a relative movement by locking the tip cover ontothe distal end holding portion when the pair of forceps members isopened to grasp a specified object; and a distal end release member thatis provided on an operational member by which the pair of forcepsmembers is opened and closed and that releases an engagement made by thedistal end locking member between the tip cover and the distal endholding portion at least when the pair of forceps members is closed.

The endoscopic treatment instrument according to a second aspect of thepresent invention includes a casing holding portion that is provided ata distal end of an insertion portion to be inserted into a human bodyand that holds a casing connected to a tip member by a thread, thecasing containing the tip member detachably attached to one of a pair offorceps members after being passed through a tissue in response to aclosing motion of the pair of forceps members at least one of which ispivoted openably and closably with respect to the other forceps member;a casing locking member which engages the casing holding portion and thecasing together; and a guide member that is provided at the tip coverand that controls an engagement state made by the casing locking memberbetween the casing holding portion and the casing.

The endoscopic treatment instrument according to a third aspect of thepresent invention includes: a pair of forceps members; a tip cover whichsupports a pivot shaft that pivots at least one of the pair of forcepsmembers openably and closably with respect to the other forceps member;a receiving portion that detachably holds a side of a distal end of anendoscope to be inserted into a human body; and a regulating member thatregulates a position of the distal end of the endoscope at a relativeposition with respect to the tip cover in order to restrict an amount ofprojection of the distal end of the endoscope with respect to thereceiving portion.

The endoscopic treatment instrument according to a fourth aspect of thepresent invention includes a first sheath and a second sheath to adistal end of each of which a treatment portion used to performtreatment is connected and to a proximal end of each of which a controlportion that operates the treatment portion is connected; a first holderwhich bundles the first sheath and the second sheath together; a secondholder which bundles the first sheath and the second sheath together andthat is provided nearer to the distal end than the first holder; a firstadjusting member that provides sliding friction to the second sheathwith respect to the first holder; and a second adjusting member thatprovides smaller sliding friction than the first adjusting member to thefirst sheath with respect to the second holder.

The retaining device according to a fifth aspect of the presentinvention includes: a string member that has an end and an opposite end;a tip member that is connected to the end of the string member; a threadlocking member provided at the string member; a casing that has a spacewhere the tip member and the thread locking member are contained and inwhich a tip-member locking member that is engaged with the tip member isprovided; and a hole that is formed in the casing and into which adevice that releases locking of the tip member by the tip-member lockingmember can be inserted.

The endoscopic treatment instrument according to a sixth aspect of thepresent invention includes: an insertion portion comprising a distal endand a proximal end, the distal end being inserted into the insertionportion; a treatment portion disposed to the distal end; and a controlportion disposed to the proximal end, wherein the treatment portionincludes: an extending and retractable input member operated by thecontrol portion; a first link disconnectably connected to the inputmember through a first connecting portion; a first forceps membercapable of opening and closing by the first link; a second linkdisconnectably connected to the input member through a second connectingportion; and a second forceps member freely opening and closing by thesecond link, the opening-and-closing angle of the second forceps memberbeing less significant than that of the first forceps member, and thefirst connecting portion releases the connection between the inputmember and the first link until the second forceps member is opened by apredetermined degree of openness.

The endoscopic treatment instrument according to a seventh aspect of thepresent invention includes: an insertion portion including a distal endand a proximal end, the distal end being inserted into a human body; atreatment portion disposed to the distal end; and a control portiondisposed to the proximal end, wherein the treatment portion including:an extending and retractable input member operated by the controlportion; a first link disconnectably connected to the input memberthrough a first connecting portion; a first forceps member capable ofopening and closing by the first link; a second link disconnectablyconnected to the input member through a second connecting portion; and asecond forceps member freely opening and closing by the second link, theopening-and-closing angle of the second forceps member being lesssignificant than that of the first forceps member, and the secondconnection portion releases the connection between the input member andthe second link after the input member is driven by a predeterminedlength in a direction of closing the fully open second forceps member.

The endoscopic treatment instrument according to a sixth aspect of thepresent invention includes: an insertion portion comprising a distal endand a proximal end, the distal end being inserted into the insertionportion; a treatment portion disposed to the distal end; and a controlportion disposed to the proximal end, wherein the treatment portionincludes: an extending and retractable input member operated by thecontrol portion; a first link disconnectably connected to the inputmember through a first connecting portion; a first forceps membercapable of opening and closing by the first link; a second linkdisconnectably connected to the input member through a second connectingportion; and a second forceps member freely opening and closing by thesecond link, the opening-and-closing angle of the second forceps memberbeing less significant than that of the first forceps member, and thesecond connection portion releases the connection between the inputmember and the second link when the second forceps member is fully open.

The endoscopic treatment instrument according to a ninth aspect of thepresent invention includes: an insertion portion including a distal endand a proximal end, the distal end being inserted into a human body; atreatment portion disposed to the distal end; and a control portiondisposed to the proximal end, wherein the treatment portion including: apair of forceps members; a tip cover for supporting a pivot shaft forpivoting at least one of the pair of freely opening and closing forcepsmembers relative to the other; a casing holding portion accommodated inthe tip cover, the casing holding portion supporting a casing capable ofreceiving a needle detachably attached to the forceps members; and asupporting member disposed in the casing holding portion, the supportingmember having an elastically deformable arm capable of engaging thecasing, and wherein in the casing holding portion, the arm is pressed tobe elastically deformed in the vicinity of the distal end so that thearm engages the casing, and a space is disposed in the vicinity of theproximal end so that the arm disengaged from the casing is restored toopen in the space.

In the attaching device according to a tenth aspect of the presentinvention in use for attaching a cartridge to a suture instrument, thecartridge is connected to a casing capable of accepting a suture threadput through a detachable thread attached to the suture instrument, thedevice comprises: a needle-supporting section for supporting thedetachable needle, the needle-supporting section being capable ofaccepting the suture instrument; and a holder for accommodating thecasing, the holder being urged in a direction separate from the sutureinstrument.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a view showing a schematic structure of a suture instrumentwhich is an embodiment of an endoscope and an endoscopic treatmentinstrument;

FIG. 2 is a view on arrow A in FIG. 1, showing a structure of a controlportion;

FIG. 3 is a partial sectional view showing a structure of an insertionportion;

FIG. 4 is a view of a valving element along line B-B in FIG. 1;

FIG. 5 is a sectional view along line C-C in FIG. 4;

FIG. 6 is an enlarged view of a distal end of the suture instrument;

FIG. 7 is a view on arrow D in FIG. 6;

FIG. 8 is a view on arrow E in FIG. 6;

FIG. 9 is a sectional view along line F-F in FIG. 7;

FIG. 10 is a sectional view obtained when a forceps member is opened;

FIG. 11 is a view on arrow G in FIG. 10;

FIG. 12 is a sectional view showing a treatment instrument including adetachable needle, a casing, and a suture thread;

FIG. 13 is a sectional view along line H-H in FIG. 12, showing a statein which the detachable needle has been locked;

FIG. 14 is a view showing an example of a device for releasing thelocking of the detachable needle;

FIG. 15 is a sectional view taken along line I-I in FIG. 13;

FIG. 16 is a sectional view for illustrating a suture method, showing astate in which a forceps member has been opened toward an incision;

FIG. 17 is a sectional view showing a state in which the forceps memberhas been closed so as to pinch tissues including the incision;

FIG. 18 is a view showing one aspect of the control portion that canreliably perform a needle-inserting operation twice;

FIG. 19 is a view showing another aspect of the control portion that canreliably perform a needle-inserting operation twice;

FIG. 20 is a sectional view along line J-J in FIG. 19;

FIG. 21 is a sectional view along line K-K in FIG. 20;

FIG. 22 is a view showing a state in which a stopper releasing buttonhas been pushed from the state in FIG. 21;

FIG. 23 is a sectional view showing a state in which the detachableneedle has been inserted into the casing by pulling a tip cover and theforceps member;

FIG. 24 is a view showing a state in which the detachable needlecontained in the casing has been detached from a curved needle byreturning the tip cover and the forceps member toward the distal end;

FIG. 25 is a view showing a state in which the forceps member has beenopened after detaching the detachable needle from the curved needle;

FIG. 26 is a view showing a state in which the treatment instrument isretained while the incision has been sutured;

FIG. 27 is a sectional view showing a distal claw portion formedintegrally;

FIG. 28 is a view showing a structure in which a distal-end supportingportion, a bridge portion, and a casing holding portion are formedintegrally with each other;

FIG. 29 is a view showing a distal end of a suture instrument accordingto another embodiment, in which a receiving portion is provided with acut;

FIG. 30 is a view showing a receiving portion provided with a cut and atapered surface;

FIG. 31 shows a modified example of a first locking member.

FIG. 32 is a view showing a schematic structure of a suture instrumentwhich is an embodiment of an endoscope and an endoscopic treatmentinstrument;

FIG. 33 is a cross section showing an area L shown in FIG. 32.

FIG. 34 is a cross section showing an area M shown in FIG. 32.

FIG. 35 is a cross-sectional view taken along the line N-N of FIG. 34.

FIG. 36 is a partial cross sectional view showing a structure of aninsertion portion;

FIG. 37 is a schematic diagram of an endoscopic image;

FIG. 38 is a cross sectional view of a tip portion of a sutureinstrument;

FIG. 39 is a partial cross sectional view showing a structure of aninsertion portion;

FIG. 40 is a view on arrow P in FIG. 38;

FIG. 41 is a view on arrow Q in FIG. 40;

FIG. 42 illustrates an open state of a pair of forceps members;

FIG. 43 is an enlarged view of a hook;

FIG. 44 is a cross-sectional view taken along the line R-R of FIG. 43;

FIG. 45 is a cross sectional view showing a structure of a cartridge;

FIG. 46 is a cross-sectional view taken along the line S-S of FIG. 45;

FIG. 47 illustrates a casing viewed from an insertion direction of andetachable needle;

FIG. 48 illustrates a closed sate of the pair of forceps members;

FIG. 49 illustrates an extended casing containing the detachable needle;

FIG. 50 illustrates the casing withdrawn to be separate from thedetachable needle;

FIG. 51 illustrates an extruded state of casing from the open pair offorceps members;

FIG. 52 is a view showing a scope holder attached to the endoscope;

FIG. 53 illustrates the scope holder viewed from a half end.

FIG. 54 is a view showing an example of the scope holder;

FIG. 55 is a view showing a modified example of a binding band;

FIG. 56 shows the scope holder using the binding band shown in FIG. 55;

FIG. 57 illustrates the scope holder unitarily formed with a lockingmember;

FIG. 58 is a cross sectional view showing another aspect of a valvingelement;

FIG. 59A is a side cross sectional view of a cartridge in a modifiedexample;

FIG. 59B is a cross sectional view illustrating a modified example ofthe cartridge shown in FIG. 59A;

FIG. 60 is a plan cross sectional view of the cartridge shown in FIGS.59A and 59B.

FIG. 61 illustrates a modified example of the hook in an enlarged viewshowing a tip portion of the suture instrument;

FIG. 62 shows a withdrawn state of a suture thread pulled by the hook;

FIG. 63 is a cross sectional view showing the distal end portion of asuture instrument where forceps members are driven by separate links;

FIG. 64 is a perspective view for explaining the disposition of thelinks;

FIG. 65 illustrates a process for rotating the pair of forceps membersin the closing directions;

FIG. 66 illustrates the rotated state of both of the pair of forcepsmembers by 90°;

FIG. 67 illustrates the fully closed and stopped forceps member and a135° rotated state of the not fully closed forceps member;

FIG. 68 illustrates a closed state of the pair of forceps members;

FIG. 69 illustrates the forceps members rotated from the closed state tothe open state;

FIG. 70 illustrates the forceps members shown in FIG. 67 rotated in theopening direction;

FIG. 71 illustrates an actuated state of the forceps members;

FIG. 72 describes in a graph the action of the pair of forceps membersin accordance with a varied strode of a rod;

FIG. 73 describes in a graph the action of the pair of forceps membersin accordance with a varied strode of the rod;

FIG. 74 describes in a graph the action of the pair of forceps membersin accordance with a varied strode of the rod;

FIG. 75 describes in a graph the action of the pair of forceps membersin accordance with a varied strode of the rod;

FIG. 76 illustrates the action corresponding to FIG. 72;

FIG. 77 illustrates the action corresponding to FIG. 72;

FIG. 78 illustrates the action corresponding to FIG. 72;

FIG. 79 illustrates the action corresponding to FIG. 72;

FIG. 80 illustrates the action corresponding to FIG. 72;

FIG. 81 illustrates the action corresponding to FIG. 72;

FIG. 82 is a view showing the outlook of an applicator;

FIG. 83 is a view on arrow T in FIG. 82;

FIG. 84 illustrates an attaching portion with a base plate removedtherefrom;

FIG. 85 is a plan view of the base plate;

FIG. 86 is a perspective view showing the holder and the cartridgeattached thereto;

FIG. 87 is a perspective view showing a thread holder;

FIG. 88 is a cross sectional view showing the cartridge;

FIG. 89 illustrates an action for attaching the cartridge to the sutureinstrument;

FIG. 90 illustrates the suture instrument engaging the attaching device;

FIG. 91 illustrates the suture instrument engaging the attaching device;

FIG. 92 illustrate the casing forced with the hook;

FIG. 93 illustrates the thread holder pulled with the suture thread byreturning the hook;

FIG. 94 illustrates the withdrawn state of a holder pulled by coiledspring;

FIG. 95 illustrates the withdrawn state of the holder pulled by the hookvia the suture thread;

FIG. 96 illustrates the casing removed from the holder;

FIG. 97 illustrates another embodiment of the air supply device;

FIG. 98 illustrates an attaching device with a base plate removedtherefrom;

FIG. 99 illustrates procedures for attaching the cartridge having thesuture thread hooked on the hook;

FIG. 100 illustrates the withdrawn state of the rod having the suturethread tensioned by pushing a button;

FIG. 101 illustrates the withdrawn state of the rod pulled by the hookvia the suture thread;

FIG. 102 illustrates an example of a control portion; and

FIG. 103 is a view showing a modified example of the attaching device.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments of the present invention will be hereinafter described indetail with reference to the accompanying drawings. The same referencenumerals are added to the same elements as those shown in eachembodiments. In addition, overlapping descriptions between theembodiments will be omitted.

First Embodiment

FIG. 1 shows a suture instrument that is an example of an endoscopictreatment instrument. A suture instrument (applicator) 1 has a longinsertion portion 3 extended from a control portion 2 that is operatedby an operator. The insertion portion 3 is inserted in an overtube 6together with an endoscope inserting part 5 of an endoscope 4. The tipof the insertion portion 3 projects from the distal end of the overtube6. A treatment portion 7 is attached to the tip of the insertion portion3.

As shown in FIG. 2, the control portion 2 has an elongated control body10 that has a rigid shaft extending in an insertion direction. Theinsertion portion 3 extends from a distal end 10A of the control body10. A finger-hook ring 11 is attached to the proximal end of the controlbody 10. A slit 12 is provided along a length direction of the controlbody 10 on the side nearer to the distal end than the ring 11. A forcepsoperating portion 13 and a hook operating portion 14, in order from theside of the ring 11, are attached to the slit 12 independently andslidably in the axial direction of the control body 10. ABS(acrylonitrile butadiene styrene) resin, polycarbonate, polyacetal,polyphenylsulfone, polyphthalamide, or polyether ether ketone can bementioned as a material of the control portion 2. The instrument can beproduced at low cost by making the control portion 2 of ABS resin,polycarbonate, or the like. Since slidability is increased by making thecontrol portion 2 of polyacetal, a physical force required in operatingthe instrument can be reduced. Additionally, since excellent chemicalresistance and excellent heat resistance can be obtained by making thecontrol portion 2 of polyphenylsulfone, polyphthalamide, or polyetherether ketone, a change in quality caused by disinfection orsterilization becomes small.

A forceps operating wire (a forceps operating member, a first wire) 15is fixed to the forceps operating portion 13. The forceps operating wire15 is guided to the inside of the insertion portion 3 through the insideof the slit 12. In the hook operating portion 14, a pair of handles 16extend from a side of a cylinder 14A toward the proximal end, and afinger-hook ring 17 is formed integrally with the base of the handle 16.The interval between the pair of handles 16 is large enough to allow theentry of the forceps operating portion 13. The hook operating portion 14can have a long stroke by pulling the ring 17 of the handle 16 beyondthe forceps operating portion 13. A hook operating wire (a hookoperating member, a second wire) 18 is fixed to the hook operatingportion 14. The hook operating wire 18 is guided to the inside of theinsertion portion 3 through the inside of the slit 12. The number of thehandles 16 may be one, or may be more than two.

Each of the control body 10, the forceps operating portion 13, and thehook operating portion 14 is made out of a resinous molded article, andare produced by fixing integrally-molded members in a snap-fit manner.In more detail, the control body 10 is produced by bending a developedmember and then fixing this by a snap-fit connection. An independentlymolded ring 11 is fitted to the proximal end of the control body 10.Each of the forceps operating portion 13 and the hook operating portion14 is produced by bending a developed member in such a way as to coverthe control body 10 and then fixing this by a snap-fit connection.

As shown in FIG. 3, the insertion portion 3 has a hook sheath 21extending from the distal end of the control portion 2 and a forcepssheath 22. The hook operating wire 18 is passed movably back and forththrough the inside of the hook sheath 21. The forceps operating wire 15is passed movably back and forth through the inside of the forcepssheath 22.

A movement control portion (a first holder) 25 that is a constituent ofthe control portion 2 and a scope holder (a second holder) 26 aredisposed at the path of the insertion portion 3. The two sheaths 21 and22 are bundled in parallel with each other by the movement controlportion 25 and the scope holder 26. The movement control portion 25 hasthrough-holes 30 and 31 that are formed in parallel with each other andthrough which the two sheaths 21 and 22 pass, respectively. A firstadjusting member 32 is inserted in the through-hole 30 for the hooksheath 21 in such a way that its end projects therefrom. In thisembodiment, a screw is used as the first adjusting member 32. Thesliding friction of the hook sheath 21 is increased by tightening thefirst adjusting member 32 so as to come into contact with the hooksheath 21. On the other hand, the forceps sheath 22 is fixed to themovement control portion 25 in a state of being inserted in thethrough-hole 31.

The scope holder 26 has a holder body 35 having through-holes 33 and 34that are formed in parallel with each other and through which the twosheaths 21 and 22 pass, respectively. A cylindrical receiving portion 36through which the endoscope inserting part 5 of the endoscope 4 passesfrom the holder body 35 is formed integrally therewith. The through-hole34 is formed in the scope holder 26. The forceps sheath 22 is insertedin the through-hole 34 movably back and forth. A second adjusting member37 is disposed so as to come into contact with the forceps sheath 22. Inthis embodiment, a screw is used as the second adjusting member 37. Thesliding friction of the forceps sheath 22 is increased by tightening thesecond adjusting member 37 so as to come into contact with the forcepssheath 22. On the other hand, no adjusting member is disposed at thethrough-hole 33 of the hook sheath 21 so as to be movable back andforth.

Both sheaths 21 and 22 proceed toward the scope holder 26 either bygripping the sheaths 21 and 22 exposed between the scope holder 26 andthe movement control portion 25 or by extending the movement controlportion 25. Since the endoscope 4 held by the scope holder 26 does notmove, the treatment portion 7 attached to the distal ends of bothsheaths 21 and 22 can be extended toward the endoscope 4.

On the other hand, when an operator intends to extend only the hooksheath 21, the hook sheath 21 is gripped to be extended. At this time,the movement control portion 25 is not moved by the first adjustingmember 32. The reason is that the sliding friction in the movementcontrol portion 25 of the hook sheath 21 is small, and the slidingfriction caused by the second adjusting member 37 in the scope holder 26of the forceps sheath 22 is great. Therefore, the hook sheath 1121slides with respect to the movement control portion 25, and only thehook sheath 21 is extended.

Thus, the movement control portion 25 and the scope holder 26 make itpossible to properly use the sheaths 21 and 22 so as to extend both ofthe sheaths 21 and 22 or extend only the hook sheath 21. The sheaths 21and 22 being operated can be more easily confirmed by making adifference in color between the hook sheath 21 and the forceps sheath22, by making the surface of one of the sheaths 21 and 22 uneven, or bymaking a difference in outer diameter between the sheaths 21 and 22, inorder to help the operator to operate the instrument.

The sliding friction caused by the first and second adjusting members 32and 37 can be adjusted by an amount of tightening. According to anotheraspect, O rings may be used as the first and second adjusting members 32and 37.

The movement control portion 25 and the scope holder 26 are produced byfixing integrally-molded members with a snap-fit. In more detail, themovement control portion 25 and the scope holder 26 are producedaccording to the following way. The sheaths 21 and 22 are passed throughgrooves of developed members, which become the through-holes 30, 31, 33,and 34, and the first adjusting members 32 and 37 are inserted.Thereafter, the developed members are bent and fixed by a snap-fitconnection.

The hook sheath 21 is inserted in a coil sheath 41. The forceps sheath22 is inserted in a coil sheath 42. The two coil sheaths 41 and 42extend forwardly from the scope holder 26. Each of the coil sheaths 41and 42 is made out of a flat coil obtained by closely winding a flatmetallic plate. From this structure, component cost can be reduced, andthe number of assembling steps can be reduced, when compared to aconventional structure in which tubes are used. The outer surface ofeach of the hook sheath 21 and the forceps sheath 22 is covered with aheat-shrinkable tube made of low density polyethylene, high densitypolyethylene, or fluorine resin such as FEP or PFA, or the like. If theheat-shrinkable tube is made of low density polyethylene, the slidingfriction with the coil sheaths 41 and 42 can be reduced, and,additionally, the heat-shrinkable tube can be produced at low cost. Ifthe heat-shrinkable tube is made of high density polyethylene, thesliding friction can be reduced further. If the heat-shrinkable tube ismade of fluorine resin such as FEP or PFA, a change in quality caused bydisinfection or sterilization is slight, because the fluorine resin hassmall sliding friction and is superior in chemical resistance and heatresistance. The instrument can be operated with a small force byallowing each of the above examples to reduce sliding friction.

As shown in FIG. 1, a valving element 50 which bundles the two coilsheaths 41 and 42 and the endoscope inserting part 5 of the endoscope 4together and by which an airtight structure is formed between thevalving element 50 and the overtube 6 is disposed midway on theinsertion portion 3. Silicone rubber, natural rubber, or isopropylenerubber, or the like can be mentioned as a material of the valvingelement 50. The valving element 50 is fixed to the coil sheaths 41 and42, for example, with an adhesive. As shown in FIG. 4 and FIG. 5, thevalving element 50 has through-holes 51 and 52 for the sheaths 41 and 42and a through-hole 53 for the endoscope 4 that are formed in parallelwith each other. The valving element 50 has tapered surfaces 54 and 55formed by slantingly cutting both end surfaces of a cylindrical member.The length in the insertion direction of a part 52A on the opposite sideof the through-hole 52 is shortened by the tapered surfaces 54 and 55. Apress-fit part 56, whose outer shape is a substantially circular arcwhen viewed cross-sectionally, is formed on the outer periphery of thevalving element 50. A press-fit part 57 having the same shape as thepress-fit part 56 is formed on the inner periphery of the through-hole53 used for the endoscope 4. Since the tapered surfaces 54 and 55 areprovided, the valving element 50 is not easily caught by the overtube 6.Since the press-fit part 56 is further provided, the valving element 50comes into contact with the overtube 6 at only one place in theinsertion direction. Therefore, from a decrease in contact area, thesliding friction is expected to be reduced, and it becomes easy toinsert the endoscope inserting part 5. Likewise, since the press-fitpart 57 makes a contact area with the endoscope inserting part 5 small,it becomes easy to insert the endoscope inserting part 5. Additionally,since the rigidity is improved by making a part 55A thick, the valvingelement 50 can be prevented from being deformed. Since the opening ofeach of the through-holes 51 to 53 is tapered to enlarge the outerdiameter, the coil sheaths 41 and 42 and the endoscope inserting part 5can be easily inserted.

Next, the treatment portion 7 will be described.

As shown in FIG. 6 to FIG. 8, a receiving portion 60 is fixed to thedistal end of the insertion portion 3. As shown in FIG. 8, the receivingportion 60 has a C-shaped base 61 into which the endoscope insertingpart 5 of the endoscope 4 can be inserted. Since a part of the base 61is cut off, an outer shape obtained by combining the endoscope insertingpart 5 and the suture instrument 1 together becomes small, and thediameter of the overtube 6 can be reduced. Additionally, a contact areabetween the receiving portion 60 and the overtube 6 can be reduced. Fromthese, the insertion into the overtube 6 or into body cavities can beeasily performed. To secure the connection strength between the base 61and the endoscope 4, a flexible member 62 is affixed to the inner sideof the base 61. The flexible member 62 additionally has a function toprevent the base 61 from damaging the endoscope 4.

As shown in FIG. 6 and FIG. 7, in the receiving portion 60, a taperportion 63 is formed at the proximal end toward which the coil sheaths41 and 42 are pulled in. The taper portion 63 is formed to reduce theouter diameter of the receiving portion 60 toward the proximal end. As aresult, the outer periphery of the base 61 is not caught by the taperportion 63 when the treatment portion 7 drawn out from the overtube 6 isagain contained in the overtube 6 during manipulation.

As shown in FIG. 9, a cylindrical hole 71A to which the distal end ofthe coil sheath 42 is fixed on the outer periphery thereof is disposedin the receiving portion 60. A distal-end supporting member 71 isdisposed movably back and forth in a hole 71B. The distal-end supportingmember 71 extends along the axial line of the coil sheath 42. Theforceps sheath 22 is fixed to the proximal end thereof, and the forcepsoperating wire 15 is passed through the inside thereof.

A hole 72 and a slit 73 are formed in the distal end of the distal-endsupporting portion 71. The hole 72 and the slit 73 are formed on thestraight line of the distal-end supporting portion 71, and an end of theslit 73 extends nearer to the proximal end than the hole 72. A pin 75that is a first locking member (a distal-end locking member) is insertedin the hole 72. A part of the pin 75 projects into the distal-endsupporting portion 71 in a state in which the pin 75 is inserted in thehole 72. The pin 75 is attached to the outer periphery of the distal-endsupporting portion 71 by a leaf spring 76 serving as an urging member.The leaf spring 76 is urged in a direction in which the pin 75 iscontained in the hole 72. On the other hand, an elongated release member77 is inserted in the slit 73. The release member 77 is a second releasemember (a forceps release member) fixed to the distal-end supportingportion 71 by, for example, laser welding or by an adhesive. A proximalend of an elongated plate member and the distal-end supporting portion71 in the direction of the center axis are slantingly cut.

A tube part 81 of a tip cover 80 is inserted in the distal-endsupporting portion 71 from the side of the distal opening. The tip cover80 has the tube part 81 that has the outer diameter substantially equalto the inner diameter of the distal-end supporting portion 71 and acover body 82 formed integrally at the tip of the tube part 81. A coiledspring 83 is disposed outside the tube part 81. An urging force isapplied so as to separate the cover body 82 from a bridge portion 85fixed to the distal opening of the distal-end supporting portion 71. Thebridge portion 85 extends in a direction perpendicular to the insertiondirection. The tip of the distal-end supporting portion 71 is fixed toan end of the bridge portion 85, and the proximal end of a cartridgesupporting member 86 described later is fixed to an opposite end of thebridge portion 85.

A plurality of slits 91, 92, and 93 are formed in the tube part 81 inthe length direction. The slit 91 is formed according to the position atwhich the hole 72 of the distal-end supporting portion 71 is formedaround the axial line of the tube part 81. The slit 91 has a width so asnot to allow entry of the pin 75. However, only a base 91A of the slit91 is increased in width, so that the tip of the pin 75 can enter theslit 91. The slit 92 is formed according to the position at which theslit 73 of the distal-end supporting portion 71 is formed around theaxial line. The slit 92 has a width large enough to insert the releasemember 77. The base of the slit 92 extends nearer to the proximal endthan the base 91A of the slit 91.

As shown in FIG. 6, the slit 93 is formed at a position where the otherslits 91 and 92 are avoided. A pin 95 fixed to the bridge portion 85 isinserted in the slit 93 so as to be used as a slide guide of the tubepart 81.

As shown in FIG. 9, a rod 100 that is a constituent of an opening andclosing mechanism is inserted in the tube part 81 movably back andforth. The forceps operating wire 15 is fixed to the proximal end of therod 100. A concave portion 101 extending in the radial direction isformed at a position near to the proximal end of the rod 100. A ball 102serving as a second locking member (a forceps locking member) isinserted in the concave portion 101. The ball 102 is urged by a coiledspring 103 outwardly in the radial direction. The ball 102 can enter alarge-diameter part 92A provided on the base of the slit 92 of the tubepart 81, but cannot enter a more forward part than the large-diameterpart 92A.

A release member 105 serving as a first release member (a distal-endrelease member) is provided at a position that is occupied moreforwardly than the ball 102 and that is obtained by the rotation aroundthe axial line by 180 degrees. The release member 105 projects at aposition where the release member 105 coincides with the ball 102 aroundthe rotational axis. The base of the release member 105 has a taperedsurface by which the pin 75 can easily ride.

An end of each of two link members 111 and 112 is rotatably attached tothe tip of the rod 100 via a pin 110. An opposite end of the link member111 is rotatably attached to an end 115A of a forceps member 115 via apin 113. The forceps member 115 has a bent part 115C between the end115A of the forceps member 115 and an opposite end 115B thereof. Thebent part 115C is rotatably pivoted on the tip cover 80 by means of apin (pivot shaft) 116. A curved needle (attaching portion) 120 is fixedto the opposite end 115B of the forceps member 115. A detachable needle121 is detachably attached to the tip of the curved needle 120. Thedetachable needle 121 has the pointed end part, a diameter-reducedcontracted part 122 next to the pointed end part, and then a proximalend part 123. The proximal end part 123 is fitted to the curved needle120. An end of a suture thread 125 is drawn in the proximal end part123, and is fixed there. The contracted part 122 is formed when thesuture thread 125 inserted therein is fixed while caulking concave partsformed on the detachable needle 121 from the four directions. Accordingto this structure, the outer diameter of the detachable needle can bemade smaller than a conventional detachable needle to which a suturethread is fixed by use of the knot of the suture thread. The suturethread 125 is drawn out through a slit 120A of the curved needle 120.

On the other hand, the opposite end of the other link member 112 isrotatably connected to the proximal end of an intermediate member 131Aby means of a pin 130. The distal end of the intermediate member 131A isrotatably supported by the tip cover 80 via a pin 132. A forceps member131 is rotatably pivoted on the tip cover 80 by means of the pin (pivotshaft) 132 on the side of the proximal end. A tip part 131B of theforceps member 131 is shaped like a ring having an opening 133, and iscurved forwardly. A needle 134 that is inserted into tissues is fixed tothe forefront of the forceps member 131.

As shown in FIG. 10, when the pair of forceps members 115 and 131 isopened, the tip of the detachable needle 121 attached to the curvedneedle 120 and the tip of the needle 134 of the forceps member 131coincide with each other in the insertion direction. Since the needles121 and 134 are inserted into tissues substantially simultaneously, theneedles 121 and 134 do not easily come off from the tissues, and can bereliably inserted thereinto. Additionally, the needles 121 and 134 canbe inserted deep thereinto.

As shown in FIG. 6, in the forceps member 131, a part 131C supported bythe tip cover 80 via the pin 132 is disposed outside the tip cover 80.The tip cover 80 has a concave part 80B, and the part 131C of theforceps member 131 is supported by the concave portion 80B via the pin1321. As shown in FIG. 7, a large difference in level does not exist atthe boundary between the part 131C of the forceps member 131 and the tipcover 80, and hence the endoscope can be easily inserted into the bodycavities, and the operability is improved.

Additionally, since the forceps member 131 is supported outside the tipcover 80, a space used to dispose a charging spring that urges theforceps member 131 so as to be reliably closed is secured in the tipcover 80. As shown in FIG. 7 and FIG. 9, a charging spring 140 is woundlike a coil with the pin 132 provided with a clearance. When the pair offorceps members 115 and 134131 is closed, an end 140A of the chargingspring 140 comes into contact with the proximal end of the intermediatemember 131A. An opposite end 140B of the charging spring 140 comes intocontact with the part 131C of the forceps member 131. When the pair offorceps members 115 and 131 is closed, the charging spring 140 appliesan urging force so as to completely close the opposite end 131B of theforceps member 131.

Since the charging spring 140 is wound like a coil, both of the ends140A and 140B extend toward mutually different positions in the widthdirection. As shown in FIG. 11, the end 140A is disposed outside,whereas the opposite end 140B is disposed near the center. FIG. 11 showsa state in which the pair of forceps members 115 and 131 has beenopened, and the charging spring 140 does not function. An opposite end112A of the intermediate member 131A is expanded outwardly in the widthdirection so as to come into contact with the end 140A of the chargingspring 140. On the other hand, the inside of the opposite end 112A ofthe intermediate member 131A is cut off, and the opposite end 112Athereof is deformed in the width direction. Since the opposite end 112Aof the intermediate member 131A is structured in this way, interferencebetween the intermediate member 131A and a casing 150 can be preventedwhen the casing 150 is moved back and forth. Additionally, in thestructure to avoid the casing 150, adequate rigidity can be obtained byforming the deformed structure.

As shown in FIG. 6, the forceps members 115 and 131 are provided withprojecting stoppers 151 and 152, respectively, that come into contactwith a tip surface 80A of the tip cover 80 when the pair of forcepsmembers 115 and 131 is completely closed. Since the stoppers 151 and 152come into contact therewith, the forceps member 115 does not sag, andthe axial line of the detachable needle 121 is not easily deviated whenthe pair of forceps members 115 and 131 is closed.

Next, a description will be given of the casing 150 into which theopposite end of the suture thread 125 is drawn as shown in FIG. 9 andthe casing supporting portion 86 that supports the casing 150.

As shown in FIG. 12 and FIG. 13, the casing 150, the suture thread(string member) 125, and the detachable needle (tip member) 121constitute a cartridge (also called a “retaining device”) 153 that isretained in the body.

The casing 150 is formed by combining cylindrical members 161 and 162together, and has a reception hole 163 into which the detachable needle121 can be inserted. The distal end side of the reception hole 163 has atapered surface 163A by which the axial line of the reception hole 163and the axial line of the detachable needle 121 are allowed to easilycoincide with each other. A wire spring 165, which is a needle lockingmember (tip-member locking member) used to prevent the detachable needle121 from falling off, is inserted in the reception hole 163. The wirespring 165 is formed by bending a rod like the letter U and bending bothends 166 of the wire spring 165 by 90 degrees so as to become parallelin the same direction. The ends 166 of the wire spring 165 are disposedto reduce the width of the reception hole 163. In an initial state, theends 166 of the wire spring 165 are contained in a groove 167 the widthof which is greater than that of the reception hole 163. When thedetachable needle 121 enters the reception hole 163, both ends 166 canbe expanded. As shown in FIG. 13, when the detachable needle 121 iscontained in the reception hole 163, the proximal end part 123 of thedetachable needle 121 is completely contained in the casing 150.Therefore, tissues are never damaged by the proximal end part 123 of thedetachable needle 121.

Polyphenylsulfone, polyphthalamide, polyether ether ketone, titaniumalloy, or pure titanium can be mentioned as a material of the casing150. If the casing 150 is made of polyphenylsulfone, polyphthalamide, orpolyether ether ketone, the casing 150 does not easily undergo a changein quality in the living body, because they are superior in chemicalresistance and acid resistance. Since these materials are also superiorin welding, an assembling operation can be performed by use ofultrasonic wave welding or laser welding. Pure titanium or titaniumalloy is superior in biocompatibility.

When the detachable needle 121 is contained in the casing 150, the wirespring 165 pinches the contracted part 122 of the detachable needle 121.If an operator intends to pull out the detachable needle 121 from thecasing 150, the wire spring 165 is moved and slid together therewith,and the end 166 enters a narrow part 168 (see FIG. 12) on the distal-endside. Since the end 166 cannot be opened here, the wire spring 165serves as a stopper, and prevents the detachable needle 121 from fallingoff. If the operator intends to pull out the detachable needle 121 fromthe casing 150, it is recommended to insert a release device into arelease hole 170 formed in the side of the casing 150 and then returnthe wire spring 165 to the proximal end side as shown by the arrow inFIG. 13. As a result, the end 166 returns to the groove 167, wherebyboth ends 166 can be opened while being pushed. Therefore, thedetachable needle 121 can be pulled out from the casing 150 by pullingthe detachable needle 121 in a state of fixing the position of the wirespring 165.

For example, a device having a structure in which a holding member 181of a forceps 180 is provided with a release pin 182 can be mentioned asthe release device as shown in FIG. 14. If the operator inserts therelease pin 182 through the release hole 170 by operating the instrumentfrom the proximal end thereof, the detachable needle 121 can be pulledout from the casing 150 even during the manipulation. The form of therelease device is not limited to that in FIG. 14. Any type of device canbe employed as long as the device can be inserted through the releasehole 170, and the wire spring 165 can be moved toward the proximal endside.

As shown in FIG. 12 and FIG. 15, the suture thread 125 drawn into thecasing 150 is pulled into the reception hole 163 from a position nearerto the proximal end than an area that the detachable needle 121 enterson the midway of the reception hole 163. The proximal end of thereception hole 163 leads to a large-diameter hole 190 formed in thesurface of the proximal end of the casing 150. A brake portion (threadlocking member) 191 is disposed inside the hole 190. The brake portion191 has a flat shape obtained by winding a metallic plate 193 around anelastic member 192 through which the suture thread 125 is passed andthen flattening the metallic plate 193. Predetermined sliding frictionis generated between the suture thread 125 and the brake portion 191.The casing 150 has a slit 194 passing through the casing 150 in theradial direction. The brake portion 191 is loosely fitted to the slit194. Since a step 195 formed between the hole 190 and the slit 194functions as a stopper of the brake portion 191, the brake portion 191never projects out of the casing 150 even when the brake portion 191 ispulled in the length direction of the suture thread 125. The brakeportion 191 makes it possible to generate predetermined sliding frictionwhen the casing 150 is moved between an end of the suture thread 125 andthe opposite end thereof, and, as a result, the movement of the casing150 is restrained.

Herein, the end of the suture thread 125 pulled out from the surface ofthe proximal end of the casing 150 forms a loop (hook catching portion)200. A double, drawn-untied knot 201 is employed to form the loop 200.Since the double, drawn-untied knot 201 can make a knot of the loop 200small, the loop 200 can be easily inserted into the hook sheath 21 evenif the inner diameter of the hook sheath 21 is small.

As shown in FIG. 10, the casing 150 is contained in the casingsupporting member 86. A ball (a third locking member, a casing lockingmember) 205 that is inserted through the hole 203 of the casingsupporting member 86 is engaged with each annular concave portion 202formed on the side of the casing 150. The ball 205 is urged to befastened to the casing 150 by a leaf spring 206 serving as an urgingmember fixed to the casing supporting member 86. It is permissible tounite the ball 205 and the leaf spring 206 together by use of laserwelding or an adhesive. The end of the casing supporting member 86 isinserted movably back and forth in a guide hole 210 used as a guidemember of the tip cover 80. The guide hole 210 has its proximal endwhose diameter has been increased. The ball 205 can be moved outwardlyin the radial direction in a part 210A widened as shown in FIG. 9. Adistal end part 210B is smaller in the diameter of the guide hole 210than the diameter-increased part 210A, and hence the ball 205 cannot bemoved outwardly in the radial direction.

In the casing supporting member 86, a distal claw portion 211 attachedto the hook sheath 21 is fitted into the hole 190 of the casing 150. Thedistal claw portion 211 has a flange 211A that serves as a stopper bycoming into contact, from the distal end side, with a step 86A formed onthe inner periphery of the casing supporting member 86. A hook 212 iscontained in the through-hole thereof. The hook 212 is fixed to the tipof the hook operating wire 18 passed movably back and forth through thehook sheath 21. The loop 200 (see FIG. 12) formed on the opposite end ofthe suture thread 125 is caught by the hook 212. Conventionally, aninner tube has been provided between the hook sheath 21 and the casingsupporting portion 86. However, in this embodiment, the structure of theinstrument is simplified by excluding the inner tube. As a result,component cost can be reduced, and the number of assembling steps can bereduced.

As shown in FIG. 7, a mark 220, which is used as a restriction part bywhich the endoscope 4 is positioned in the insertion direction, isprovided on the side of the tip cover 80 of the treatment portion 7. Arigid part of the distal end of the endoscope 4 and a rigid part of thetreatment portion 7 can be overlapped with each other in the insertiondirection by putting the distal end of the endoscope 4 onto the mark220. Conventionally, the distal end of the endoscope 4 has beenpositioned on the receiving portion 60, and hence the whole length ofthe rigid part is equal to the sum of the length of the treatmentportion 7 and the length of the rigid part of the endoscope 4.Therefore, disadvantageously, it has been difficult to achieve excellentinsertability into the overtube 6 or into the living body. However, inthis embodiment, the length of the rigid part is shortened, and henceinsertability is improved. Additionally, since the endoscope 4 isdisposed nearer to the distal end, the tip cover 80 or the otherelements do not block the visual field of an observation device of theendoscope 4. Therefore, a sufficient visual field can be obtained. Aplate member 221 caused to abut against the surface of the end of theendoscope 4 may be used as a restricting member instead of the mark 220,and may be protruded from the tip cover 80 as shown by the broken linein FIG. 7. Additionally, as shown in FIG. 8, an inclined surface 225 isformed by slantingly cutting the corner of the tip cover 80. Theinclined surface 225 makes it possible to facilitate a back-and-forthoperation, because the suture instrument 1 is contained within the innerdiameter of the overtube 6 shown by the phantom line in FIG. 8.

Next, the operation of this embodiment will be described. Although thefollowing description is concerned with a case in which an incisionformed in a stomach wall is sutured, a target region is not limited tothe stomach wall. Hollow organs, such as the esophagus, duodenum, smallintestine, large intestine, womb, or bladder may be targeted.Additionally, a natural opening through which the endoscope 4 isinserted is not limited to the mouth. The nose or anus may be used asthe natural opening. Additionally, the treatment instrument of thepresent invention may be used to suture a mucous-membrane defective partor a perforated part generated by hemostasis or an ulcer.

The endoscope inserting part 5 of the endoscope 4 is passed through thescope holder 26, the valving element 50, and the receiving portion 60 inthis order, and then the surface of the end of the endoscope 4 isallowed to coincide with the mark 220. To firmly fix the endoscope 4 tothe suture instrument 1, the end of the endoscope 4 and the receivingportion 60 may be fastened together by, for example, a tape. Thereafter,the cartridge 153 is set at a desired position of the suture instrument1. The overtube 6 is inserted from the mouth of a patient to theneighborhood of the cardiac orifice of the stomach or into the stomachby use of another endoscope. Thereafter, the suture instrument 1 fixedto the endoscope 4 via the overtube 6 is inserted into the stomach.

In the interior of the stomach, the position of the incision of a tissuethat is a target region is confirmed by an observation device of theendoscope 4. Since the end of the endoscope 4 is disposed nearer to thedistal end of the suture instrument than a conventional endoscope, thevisual field is not easily blocked by the suture instrument 1, so thatthe incision of the tissue and the detachable needle 121 can come withinthe same visual field.

Thereafter, the pair of forceps members 115 and 131 is opened in theinterior of the stomach before suturing. In more detail, an operatorextends the forceps operating portion 13 of the control portion 2. Theforceps operating wire 15 is then extended, and the link members 111 and112 connected to the rod 100 allow the forceps members 115 and 131 topivot on the pins 106 and 132 and be opened. As shown in FIG. 16, whenthe thus opened forceps members 115 and 131 are allowed to approach theincision SO that is a target region, the pair of forceps members 115 and131 is closed in such a way as to pinch tissues around the incision SOwith the forceps members 115 and 131.

When the operator allows the forceps operating portion 13 of the controlportion 2 to recede therefrom, the forceps operating wire 15 recedes,and the link members 111 and 112 are pulled into the tip cover 80, sothat the forceps members 115 and 131 pivot on the pins 106 and 132,respectively, and are closed. The needle 134 of the forceps member 131is then inserted into the tissue, and presses the tissue against theincision SO. On the other hand, the curved needle 120 of the forcepsmember 115 is inserted into a tissue on the opposite side of the forcepsmember 131 with the incision SO therebetween, and is protruded towardthe casing 150 through the tissue drawn in by the forceps member 131across the incision SO. As a result, as shown in FIG. 17, the curvedneedle 120 and the suture thread 125 are passed through the incision SO.

If the incision SO is relatively large and cannot be pinched by a singlesuturing operation, it is permissible to first make a puncture in an endof the incision SO, then make a gap between the detachable needle 121and the needle 134 by widening the curved needle 120 to the extent ofabout a half, then take a tissue on the opposite side of the incision SOinto the gap, and perform a suturing operation while inserting theneedle there.

If the tissue is hard at this time, the detachable needle 121 cannot beeasily inserted through the tissue, and the forceps operating portion 13cannot be stopped at a position at which the detachable needle 121arrives through the tissue, because a large force is applied onto theforceps operating portion 13. Accordingly, the detachable needle 121 isoften moved, as a serial operation, to a position at which thedetachable needle 121 is engaged with the casing 150. If so, theincision cannot be sutured by a twice-inserting operation as describedabove. To reliably perform the twice-inserting operation, it isrecommended to structure the control portion 2 as shown in FIG. 18. Inthe control portion 2, a hole 401 leading to the slit 12 is formed inthe proximal end of the control body 10, and a cam rod 402 extended tothe end of the ring 11 is inserted in the hole 401. An abutment portion403 is disposed at the end of the hole 401 in such a way as to reducethe opening diameter. A spiral cam groove 405 is formed on the innerperiphery of the hole 401. The cam groove 405 extends in thecircumferential direction with a length greater than at least asemicircle (180 degrees). Further, a rod 406 that can pass through theabutment portion 403 extends from the cam rod 402 toward the distal end.The rod 406 is inside the slit 12, and a stopper 407 is disposed at thetip of the rod 406 so that the stopper 407 can come into contact withthe forceps operating portion 13. Further, on the outer periphery of thecam rod 402, a pin 408 extends outwardly in the radial direction. Thepin 408 is inserted in the cam groove 405, and the ring 11 is engagedwith the control body 10 with the pin 408 therebetween.

In the control portion 2, the forceps operating portion 13 can be pulleduntil the forceps operating portion 13 comes into contact with thestopper 407. When the ring 11 is rotated from the position shown in FIG.18 by 180 degrees, the rotational motion of the pin 408 rotatingtogether with the ring 11 is transformed into the linear motion of thering 11 by the cam groove 405, so that the ring 11 recedes. The stopper407 formed integrally with the ring 11 recedes by, for example, amovement amount X. Since the stopper 407 recedes, the forceps operatingportion 13 can further recede by the movement amount X. If the positionobtained at this time is set as a position to which the tip cover 80 ismoved until the detachable needle 121 is engaged with the casing 150,and if the first position of the stopper 407 is set as a first positionfor a twice-inserting operation, the twice-inserting operation will bereliably performed.

Another aspect is shown in FIG. 19. As shown in FIG. 19, an obstaclerail 410 is disposed with a predetermined length in the length directionon the inner surface of the slit 12 of the control body 10 so as to havea ridge toward the inside of the slit 12. A forceps operating portion411 is attached to the slit 12 slidably back and forth. The forcepsoperating portion 411 is a slider by which the pair of forceps members115 and 131 is opened or closed. As shown in FIG. 20, a hole 421perpendicular in the sliding direction is provided inside. A stoppermember 412 is inserted in the hole 421. The stopper member 412 is urgedby a coiled spring 414, which is an elastic member, toward an openingnarrowed in the hole 412. The end of the stopper member 412 projectsfrom the forceps operating portion 411, and is used as a stopperreleasing button 415. The stopper member 412 has a cut 416 formed in theside thereof. As shown in FIG. 21, the cut 412 is sufficiently largerthan the obstacle rail 410. However, since the position of the cut 416does not coincide with the position of the obstacle rail 410 in anatural state, the forceps operating portion 411 can recede only until astopper 413 comes into contact with the obstacle rail 410. As shown inFIG. 22, when the stopper releasing button 415 is pushed, the stopper413 is moved in proportion to the shrinkage of the coiled spring 414,and the position of the cut 416 coincides with the position of theobstacle rail 410. Since it becomes possible to avoid the obstacle rail410 by means of the cut 416, the forceps operating portion 411 can beallowed to further recede toward the ring 11. The movement amount of theforceps operating portion 411 can be controlled by allowing the operatorto push the stopper releasing button 415 provided at the end of thestopper 413 as described above, and hence the twice-inserting operationcan be reliably performed.

When the curved needle 120 and the suture thread 125 are passed throughthe incision SO, the forceps member 131 is urged by the urging force ofthe charging spring 140 in the closing direction, and the needle 134firmly bites into the tissue. Further, the stoppers 151 and 152 of theforceps members 115 and 131 are pushed against the tip surface 80A ofthe tip cover 80. As a result, the forceps members 115 and 131 areprevented from sagging, and the axial line of the detachable needle 121and the axial line of the casing 150 substantially coincide with eachother.

When the pair of forceps members 115 and 131 is completely closed, orimmediately before the pair of forceps members 115 and 131 is completelyclosed, the tapered surface of the release member 105 of the rod 100pulled into the tube part 81 of the tip cover 80 pushes the pin 75 up.The engagement between the tube part 81 and the distal-end supportingportion 71 is released by pushing the pin 75 up. As a result, the tipcover 80 can be pulled into the distal-end supporting portion 71.Therefore, when the forceps operating wire 15 is allowed to furtherrecede as shown in FIG. 23, the tip cover 80 recedes while compressingthe coiled spring 83, and the forceps members 115 and 131, which areconnected to the tip cover 80 by means of the pins 116 and 132 and thestoppers 151 and 152, recede. At this time, the ball 102 of the tubepart 81 enters the large-diameter part 92A beyond the release member 77,and the tube part 81 and the rod 100 are connected together.

On the other hand, the casing 150 is held by the casing supportingmember 86, and is not moved. Moreover, the outer periphery of the ball205 engaged with the casing 150 is covered with the small-diameter part210B of the guide hole 210 by allowing the tip cover 80 to recede, andhence the ball 205 cannot be moved outwardly in the radial direction. Asa result, in a state of preventing the movement of the casing 150, thedetachable needle 121 attached to the tip of the curved needle 120 isinserted in the casing 150. In the reception hole 163, the detachableneedle 121 is locked to the casing 150 by the wire spring 165.

When the forceps operating wire 15 is completely pulled, the forcepsoperating portion 13 is extended. The tip cover 80 starts moving to theoriginal position by the restoring force of the coiled spring 83disposed outside the tube part 81. At this time, the tip cover 80 andthe rod 100 are extended together since the tube part 81 and the rod 100are connected together by means of the ball 102 entering thelarge-diameter part 92A of the slit 92. Therefore, the pair of forcepsmembers 115 and 131 is extended without being opened, and the curvedneedle 120 attached to the forceps member 115 makes a parallel movementso as to recede from the casing 150.

The detachable needle is disengaged from the curved needle 120 by thisparallel movement. As shown in FIG. 24, the detachable needle 121 stayswhile being contained in the casing 150, and the curved needle 120recedes from the casing 150. Since the pair of forceps members 115 and131 has not yet opened at this time, interference never occurs betweenthe curved needle 120 and the casing 150. Thereafter, the ball 102proceeding together with the tube part 81 of the tip cover 80 is broughtinto contact with the release member 77, and is pushed into the rod 100by the tapered surface of the proximal end of the release member 77.Thereby, the engagement between the rod 100 and the tube part 81 isreleased, and the rod 100 becomes capable of proceeding to the tip cover80. As a result, when the forceps operating portion 13 is extended, thepair of forceps members 115 and 131 can be opened. As shown in FIG. 25,the curved needle 120 is pulled out from the tissue by opening the pairof forceps members 115 and 131. The suture thread 125 remains like aloop while being passed through the tissue.

When the suture thread 125 is tightened, the hook sheath 21 is extended.The hook sheath 21 pushes the distal claw portion 211, and the distalclaw portion 211 pushes the casing 150 from the tip cover 80 toward thetissue. Since the tip cover 80 has returned to the original position,the diameter-increased part 210A of the guide hole 210 is present aroundthe ball 205, and the ball 205 is disengaged from the concave portion202 by the elastic deformation of the leaf spring 206, so that theengagement between the casing 150 and the casing supporting member 86 isreleased. When the casing 150 is protruded from the casing supportingmember 86, the hook operating portion 14 is allowed to recede, and thehook 212 is allowed to recede. Since the suture thread 125 engaged withthe hook 212 is pulled out, the loop of the suture thread 125 passingthrough the tissue is narrowed down. Since the handle 16 of the hookoperating portion 14 can be pulled beyond the forceps operating portion13, the suture thread 125 can be pulled out until the casing 150 isbrought into contact with the tissue. As a result, as shown in FIG. 26,the incision SO is sutured by the cartridge 153. In a state in which theincision SO has been sutured, the cartridge 153 is retained in the bodyby releasing the engagement of the hook 212 or by cutting the suturethread 125 extending from the casing 150 by use of a knownthread-cutting treatment device being passed through an operatingchannel of the endoscope 4.

In this embodiment, the structure is formed so that the engagementbetween the distal-end supporting portion 71 and the tip cover 80 can bereleased by providing the pin 75 that is a first locking member in theprocess of allowing the forceps operating wire 15 to recede. Therefore,the detachable needle 121 can be inserted into the casing 150 inaccordance with an operation in which the pair of forceps members 115and 131 is closed while pulling the forceps operating wire 15. Aconventional control portion is complex in structure, and requires muchskill in operating. However, in this embodiment, the work including theengagement of the detachable needle 121 can be achieved by a series ofoperations of the forceps operating portion 13, and hence the instrumentcan be easily operated. In other words, for example, in the treatmentinstrument described by US2003-0181924A1, the hook sheath holding thecasing must be moved back and forth to engage the detachable needle withthe casing. To do so, the control portion must be shifted from one handto the other. Additionally, to engage the detachable needle with thecasing, the detachable needle and the center axis in the longitudinaldirection of the casing must coincide with each other. Therefore, anoperator must confirm this coincidence during an operation. In contrast,in this embodiment, since the engagement between the distal-endsupporting portion 71 and the tip cover 80 is released when a state inwhich the tip of the detachable needle 121 can be engaged with thecasing 150 is reached, the detachable needle 121 can be inserted intothe casing 150 in response to the closing motion of the pair of forcepsmembers 115 and 131. Therefore, operability is improved. In thisembodiment, the suture instrument is disclosed as an example of atreatment instrument. However, without being limited to this, thepresent invention can be applied to biopsy forceps or grasping forcepsthat are different in shape from the forceps members 115 and 131. If thepresent invention is applied to biopsy forceps, it will become possibleto perform the operation of pinching tissues and the operation ofremoving the tissues, as a series of operations, by an operationperformed on the side of the proximal end of the instrument. If thepresent invention is applied to grasping forceps, it will becomepossible to perform the operation of pinching tissues and the operationof transferring the tissues, as a series of operations, by an operationperformed on the side of the proximal end of the instrument.

Additionally, the structure is formed so that the link mechanism of theforceps members 115 and 131 and the tip cover 80 can be extendedtogether by providing the ball 102 that is a second locking memberbefore the pair of forceps members 115 and 131 is opened. Therefore, thepair of forceps members 115 and 131 can be kept closed until the curvedneedle 120 is completely disengaged from the casing 150. Since thepossibility that interference will occur between the curved needle 120and the casing 150 is removed, the pair of forceps members 115 and 131is reliably opened and closed. Additionally, both the disengagement ofthe detachable needle 121 from the curved needle 120 and the openingmotion of the pair of forceps members 115 and 131 are accomplished by aseries of operations of the forceps operating portion 13, and hence theinstrument can be easily operated.

Since the ball 205 by which the casing 150 and the casing supportingmember 86 are engaged together is provided as a third locking member,and since the engagement of the ball 205 is controlled by the guide hole210 of the tip cover 80, the casing 150 can be reliably fixed, and thedetachable needle 121 can be easily engaged with the casing 150.

Since the stoppers 151 and 152 that are brought into contact with thetip surface 80A of the tip cover 80 are provided on the forceps members115 and 131, the deviation of the axis of the curved needle 120 can beprevented when the pair of forceps members 115 and 131 is closed. If thedeviation of the axis of the curved needle 120 occurs, it will becomedifficult to insert the detachable needle 121 into the casing 150 or todetach the detachable needle 121 from the curved needle 120. However, inthis embodiment, these problems are solved.

Since the movement control portion 25 and the scope holder 26 areprovided in the path of the insertion portion 3, and since only the hooksheath 21 or both of the sheaths 21 and 22 are formed to simultaneouslymove back and forth, the control portion can be more easily operatedthan a conventional control portion, and the sheath that is moved backand forth by an operator can be easily imagined, thus making it easy tobecome skillful in operating. Additionally, since the movement controlportion 25 is away from the control body 10, it is easy to share theoperations.

Since the control portion (the forceps operating portion 13) thatoperates the forceps members 115 and 131 and the other control portion(the hook operating portion 14) that operates the hook 212 areintegrally provided in the control portion 2, the control portions canbe made compact, and can be easily handled. Since the hook operatingportion 14 is disposed on the side of the distal end of the instrument,and since the forceps operating portion 13 is formed to enter the spacebetween the handles 16, the stroke of the hook operating portion 14 canbe enlarged, and the suture thread 125 can be easily tightened.

Various modifications of the suture instrument 1 will be shownhereinafter.

As shown in FIG. 27, a distal claw portion 301 is fixed to the distalend of the hook sheath 21, and the hook operating wire 18 is drawntherein. Further, the distal claw portion 301 is fixed to the casingholding portion (whose end is slightly opened outwardly in the radialdirection so as to receive the casing 150) 86. A claw portion 302 isformed integrally with the tip of the distal claw portion 301, by whichthe proximal end of the casing 150 can be locked. The distal clawportion 301 is formed by molding the distal claw portion 211 and thestep 86A of the casing supporting member 86 that receives the distalclaw portion 211 integrally with each other as shown in FIG. 9, andhence both manufacturing costs and the number of assembling steps can bereduced.

As shown in FIG. 28, it is permissible to use a supporting member 310formed by integrally molding the distal-end supporting portion 71, thebridge portion 85, and the casing supporting member 86. The supportingmember 310 is bent like a crank as a whole, and can make component costsand assembly costs lower than a structure in which the distal-endsupporting portion 71 and the casing supporting member 86 are formedindividually. Metal injection molding, turning center, molding, casting,or forging can be used as the producing method.

As shown in FIG. 29, in a receiving portion 320, a cut 322 may be formedin a part that is engaged with an outer member 321 to which the tip ofthe coil sheath 41 is fixed. The receiving portion 320 is used to fixthe distal end of the endoscope 4 to a suture instrument 323. Thereceiving portion 320 holds the outer member 321 substantially in thecross-sectional shape of the letter C by means of the cut 322. Theposition of the cut 322 is a position at which the endoscope 4 and thesuture instrument 323 are brought into contact with or close to theinner surface of the overtube 6 when the endoscope 4 and the sutureinstrument 323 are combined together and are inserted into the overtube6. The outer diameter obtained by combining the endoscope 4 and thesuture instrument 323 together can be reduced by cutting the receivingportion 320 at this position, and the insertion into the overtube 6 canbe easily carried out. The suture instrument 323 has a structure inwhich the distal claw portion 301 that is engaged with the casing 150 ismoved back and forth by a sheath 326. The distal claw portion 301 ismoved back and forth inside the tip cover 80 and a casing holdingportion 325 formed integrally with the tip cover 80.

As shown in FIG. 30, in the receiving portion 320, a holding portion 330holding the outer member 321 has the cut 322 so that the cross sectionthereof has the shape of the letter C, and a tapered surface 331 that isopened toward the distal end is provided. The tapered surface 331 has acurved surface in which the axis line CL of the coil sheath 42 is acenter axis. When the tip cover 80 is allowed to recede by operating thehook sheath 21 and the forceps sheath 22, the proximal end of the casingholding portion 325 is not caught by the receiving portion 320, andhence the tip cover 80 can be smoothly moved back and forth.

The round shape pin 75 shown in FIG. 9 as the first locking member maybe replaced by an approximate columnar pin 75A as shown in FIG. 31.Using the columnar pin 75A increases the length of engagement with thehole 72, thereby prevents the first locking member from removingtherefrom during the operation. The first locking member does not removefrom tissues subject to puncture since the force necessary to releasethe engagement of first locking member becomes stable.

Second Embodiment

FIG. 32 illustrates a suture instrument according to a second embodimentinserted together with the endoscope through the overtube.

A suture instrument (applicator) 501 as an endoscopic treatmentinstrument has a long insertion portion 3 extended from a controlportion 2 that is operated by an operator. The control portion 2 isattached to an elongated control body 10 so that a forceps operatingportion 13 and a hook operating portion 14 are independently slidable.

As shown in FIG. 33 showing the enlarged cross sectional view of thearea L of FIG. 2 in FIG. 33, inserted through the distal end of thecontrol body 10 are a hook operating wire 18, a hook sheath 21, aforceps operating wire 15, and a forceps sheath 22.

A sheath fixing pipe 511 is brazed to the hook sheath 21. An offset partof the end portion of the sheath fixing pipe 511 along its axial linefrom its axial line is cut so as to form a C-shaped cross section. Tworegions are cut to form cuts 512, 513 along the axial line direction.The remaining part 514 between the cuts 512, 513 inclines so that a wallsurface closer to the proximal end opens toward the distal end. A wallsurface of the part 514 closer to the distal end is approximatelyorthogonal to the axial line. The wall surface closer to the distal endof the cut 513 inclines toward the outer periphery in the radialdirection and toward the distal end so as to prevent the inserted sheathfixing pipe 511 from being caught. Formed on the tip part section of thecontrol body 10 is a hole 515 through which the sheath fixing pipe 511can be inserted. The hole 515 has a wall section 516 to which an endsection of the sheath fixing pipe 511 is abutted, and a sectionextending from the wall section 516 forms a hole 515A having anapproximate C-shape cross section. The hole 515A has an outlineapproximately the same as the cross sectional shape of the cut sectionof the sheath fixing pipe 511. An elastically deformable hook 517 isformed by means of the circumferential wall of the hole 515 so as toextend from the hole 515A. The sheath fixing pipe 511 cannot be removedsince the hook 517 projects so as to be able to engage with the cut 513.

Inserting the sheath fixing pipe 511 through the control body 10 untilabutting its end section to the wall section 516 contains the cut 512 inthe hole 515A having an approximate C-shape, thereby regulating therotation around the axial line. Simultaneously, the hook 517 is insertedinto the cut 513. The hook 517 caught by the withdrawn wall section ofthe part 514 of the sheath fixing pipe 511 prevents the hook sheath 21from being removed. In addition, the sheath fixing pipe 511 extendingfrom the tip of the control body 10 by a predetermined length has afunction for preventing the hook sheath 21 from being broken.

The hook operating wire 18 retractably inserted through the hook sheath21 is withdrawn across the wall section 516 and inserted into the hookoperating portion 14 after passing through a hook ring 518.

As shown in FIGS. 34 and 35, the hook operating portion 14 has a pair ofclaws 519 extending across a path through which the hook operating wire18 passes, and the hook operating wire 18 is inserted through a spacebetween the claws in the hook operating portion 14. Crimped to be fixedto the tip section of the hook operating wire 18 is a wire-fixing pipe520. Engaging the wire-fixing pipe 520 to the hook operating portion 14provides a locking effect. The wire-fixing pipe 520 is disposed in aslit 521 formed between the outer periphery and an inner section of thehook operating portion 14. The slit 521 has approximately the samelength as that of the wire-fixing pipe 520, and longitudinal wallsections 521A and 521B regulate the back-and-forth movement of thewire-fixing pipe 520.

Inserted furthermore into the slit 521 is an engagement band 523. Theapproximately U-shape engagement band 523 has one open end. The bendingpart of the engagement band 523 makes surface contact with the outercircumference of the wire-fixing pipe 520 and the inner faces of thehook operating portion 14 while extending from here toward the outerperiphery of the hook operating portion 14. Its end parts are fixed tothe hook operating portion 14 in a region radially outside thepassing-through wire-fixing pipe 520. This prevents the wire-fixing pipe520 from radially moving inward therefrom.

Engaging the hook operating wire 18 at the end of the slit on the claw519 regulates the radially outwardly movement of the wire-fixing pipe520. The way the hook operating wire 18 is fixed to the hook operatingportion 14 increases extrusion resistance of the hook operating wire 18,thereby preventing the hook operating wire 18 from, even if deformed,being removed from the hook operating portion 14.

As shown in FIG. 33, a brass sheath fixing pipe 525 is crimped and fixedat an end of the forceps sheath 22. The outer periphery of the tip ofthe sheath fixing pipe 525 is enlarged to form a locking section 525A.Inserting the locking section 525A into a groove 526 formed on thecontrol body 10 allows the forceps sheath 22 to be locked with thecontrol body 10. The sheath fixing pipe 525 crimps a part of the forcepssheath 22 closer to the proximal end inserted from the locking section525A the proximal end. The locking section 525A formed closer to thedistal end facilitates insertion of a crimping tool. Also, thebrass-made sheath fixing pipe 525 can be machined easier than astainless-steel made component. Therefore, the cost can be reduced.

As shown in FIG. 36, the hook sheath 21 and the forceps sheath 22 arepassed in this order through a movement control portion 25 and a scopeholder 26. The forceps sheath 22 is fixed to the movement controlportion 25. The hook sheath 21 increases its sliding resistance at anO-ring 530 accommodated in the movement control portion 25. The O-ring530 is accommodated in one of two receiving sections 531 formed in thelongitudinal direction for containing the O-ring 530. The two receivingsections 531 each may accommodate the O-ring 530.

Also, sliding resistance of the forceps sheath 22 passing through thescope holder 26 increases at an O-ring 530 in the receiving section 532.Two receiving section 532 are formed in the longitudinal direction forcontaining the O-ring 530. The O-ring 530 may be accommodated in one ofthe receiving sections 532. A pipe 533 is crimped and fixed to a portionof the forceps sheath 22 subject to be accommodated in the movementcontrol portion 25. The pipe 533 engages a groove of the movementcontrol portion 25.

The sliding resistance caused by the forceps sheath 22 is greater thanthat caused by the hook sheath 21 when the hook sheath 21 exposedbetween the movement control portion 25 and the scope holder 26 are heldand moved back and forth since the hook sheath 21 has one braking O-ring530 while the forceps sheath 22 has two braking O-rings 530. This allowsonly the movement of the hook sheath 21 while the forceps sheath 22 doesnot move.

In order to move the two sheaths 21 and 22, the movement control portion25 is held and moved back and forth. The engagement between the forcepssheath 22 and the movement control portion 25 by means of the pipe 533provides greater back and forth moving force that overwhelms the brakingforce caused by the two O-rings 530 accommodated in the scope holder 26.The hook sheath 21 moves together with the movement control portion 25by means of the sliding resistance caused by the O-ring 530 accommodatedin the movement control portion 25.

Using the O-ring 530 for adjusting the sliding resistance in themovement control portion 25 realizes a brake appropriate for moving thesheaths 21 and 22 back and forth. If the sliding resistance of O-ringsin use with the sheaths 21 and 22 is insignificant, three or moreO-rings may be used. Braking capability and O-ring durability can beimproved. Also, an O-ring may be replaced by a tube made of resin, e.g.,silicone.

In addition, enlarging the diameter or the elemental wire of the forcepssheath 22 provides greater hardness of the coil in order to prevent thebending of the forceps sheath 22 and extending of the hook sheath 21when the movement control portion 25 is extended. Desirable hardness ofthe forceps sheath 22 in this case does not bend the forceps sheath 22when the suture instrument 501 compresses the tissues.

The diameter of the elemental wire of the hook sheath 21 is alsoenlarged in order to prevent the hook sheath 21 from yielding when thehook sheath 21 is compressed by holding the scope holder 26. This allowsthe hook sheath 21 to be compressed smoothly. Decreasing the clearancebetween the hook sheath 21 and the hook operating wire 18 provides asliding movement of the hook operating wire 18 with the hook sheath 21.Larger clearance between the hook sheath 21 and the hook operating wire18 may bend the hook operating wire 18 to serpentinly wind in the hooksheath 21. The operational stroke of the hook operating portion 14 inthis case must be increased in accordance with the serpentine hookoperating wire 18. In contrast, the suture instrument 50 having areduced clearance and a less significant stroke provides improvedoperability to the hook operating wire 18.

The forceps sheath 22 and the hook sheath 21 are inserted through thescope holder 26 in a predetermined order. The hook sheath 21 is disposedon the right-hand side of the operator and the forceps sheath 22 isdisposed on the left-hand side of the operator who holds the endoscope 4in the left hand and operates the hook sheath 21 and the forceps sheath22 by the right hand. This results in the disposition in a image 535 ofthe endoscope 4 shown in FIG. 37 where the hook is on the right-handside and a curved needle 120 is on the left-hand side. The displayederect image permits easy operation to the operator who observes it.

As shown in FIG. 36, the hook sheath 21 and the forceps sheath 22 areinserted through the coil sheath 41 and the coil sheath 42 respectivelyin the scope holder 26. Each of the coil sheaths 41 and 42 is made outof a flat and closely-wound coil obtained by closely winding a flatplate. Locking members 340 and 341 are fit in the scope holder 26 forpreventing the coil sheaths 41 and 42 from removing therefrom. Thelocking members 540 and 541 are press-fit in recesses provided closer tothe scope holder 26, and two separate protrusions 542 are provided inthe longitudinal directions of the coil sheaths 41 and 42. Theprotrusions 542 are formed alternately with respect to the longitudinaldirection of the two locking members 540 and 541 placing the coil sheath41 in between. Similarly, the protrusions 542 are formed alternatelywith respect to the longitudinal direction of the two locking members540 and 541 placing the coil sheath 42 in between. The protrusions 542entering between the wires of the coil prevents the coil sheath 41, 42from removing there. The coil sheaths 41 and 42 are fixed by adjustingthe projection of the coil sheaths 41 and 42 from the scope holder 26having the press fit locking members 540 and 541 in a state where thehook sheath 21 and the forceps sheath 22 are passed through continuousgrooves of the scope holder 26. Pressing the positioned coil sheaths 41and 42 engages them to the protrusions 542. This shortens the assemblytime and facilitates the adjusting of the lengths of coil sheaths 41 and42.

The outer periphery of the hook sheath 21 is uncoated, and the hooksheath 21 and the coil sheath 41 constitute a reduplicate structure.These uncoated stainless-steel-made sheaths 21 and 41 provide desirablesliding between the sheaths 21 and 41. The hook sheath 21 can beextended and retracted easily when the endoscope 4 is angularly bent.

The elemental wire of the manipulation side coil 21A is differentiatedfrom the elemental wire of the distal end coil 21B in the hook sheath 21as shown in FIG. 38. The enlarged diameter of the elemental wire of themanipulation side coil 21A prevents the coil from extending when thehook sheath 21 is pulled. Also, the reduced diameter of the elementalwire of the distal end coil 21B provides flexibility, therebyfacilitating the angular bending of the endoscope 4. The angularly benthook sheath 21 can be further slid with moderate force. As shown in FIG.38, a flat coil 41A constitutes a manipulation side of the coil sheath41, and a flat thick coil 41B constitutes a distal end thereof. The coilsheath 41 which is almost not extendable with the extended forcepssheath 22 improves the operability of the forceps sheath 22, therebyfacilitating the bending of the endoscope 4 at the distal end. The thickflat coil 41A reaching the distal end used in place of the flat coil 41Bcan prevent the extension of the coil sheath. The boundaries of coils21A, 21B, 41A, and 41B are welded.

The outer periphery of the hook sheath 22 is uncoated, and the hooksheath 22 and the coil sheath 42 constitute a reduplicate structure.These stainless-steel-made sheaths 22 and 42 provide desirableslidability between the sheaths 22 and 42. The enlarged diameter of theelemental wire of the manipulation side coil 22A of the forceps sheath22 prevents the extension of the coil when the forceps sheath 22 ispulled. Also, the reduced diameter of the elemental wire of the distalend coil 22B facilitates the angular bending of the endoscope 4. Theangularly bent hook sheath 22 can be further slid with moderate force.

A less significant clearance between the coil sheath 41 and the hooksheath 21 prevents an air insufflated into a body from leaking out ofthe body through the sheaths 21 and 41. The clearance between the coilsheath 42 and the forceps sheath 22 is less significant. Increased airtightness which prevents air leakage, e.g., during the insufflation of astomach, facilitates the insufflation shortly, and a previouslyinsufflated stomach will not contract instantly. Reduced number and timeof insufflation provides easy operations, thereby moderating stressexerted on the operator.

As shown in FIGS. 32, 38, 40 and 41, the distal ends of the coil sheaths41 and 42 are welded to a scope holder 550. Disposed in the scope holder550 are two tube parts 551 and 552 respectively having the coil sheaths41 and 42 connected thereto; a tube part 552 for receiving the endoscope4 so that the tube parts are united at a distal end connection section554 approximately in parallel. The three tube parts 551 to 553 in oneunit increases the parallelism between the two tube parts 551 and 552,thereby facilitating the projection and recession of the treatmentsection 7.

As shown in FIG. 40, a resin-made hood 555 is attached to an inner ring556 that is welded to the tube part 553 in one unit. This accordinglyfacilitates the machining of each component. The inner diameter of theinner ring 556 is approximately the same as the inner diameter of thehood 555, and a end surface 556A is chamfered, i.e., the inner diameterincreases radially. The outer diameter of the inner ring 556 having anannular groove 556B is greater than the inner diameter of the hood 555.The hood 555 in use having capability of supporting the endoscope 4 isnot spontaneously removed from the inner ring 556. Easy attachment ofthe hood 555 during assembly reduces man-hours in the assembly.Attaching the hood 555 includes fitting the inner ring 556 and fittingthe tip part section of the hood 555 to a groove 354B. The surface ofthe distal end of the inner ring 556 and the tube part 553 are unifiedby means of, e.g., a laser welding method. Since the depth of the groove556B of the inner ring 556 and the fitting height of the hood 555 aresubstantially obtained, the attaching strength of the hood 555 isimproved.

As shown in FIG. 41, an opening 552A at the distal end of the tube part552 is cut in an arch around a rotational axis C1 of the scope holder550, i.e., in an approximate D-shape. The scope holder 550 having asmall outer diameter can be inserted through the overtube 6. Withdrawingis facilitated even if the treatment section 7 is inclined.

As shown in FIGS. 38 and 40, the treatment section 7 has a tip cover 560supported by the scope holder 550, and a pair of forceps members 115 and131 that freely open and close are supported by the tip cover 560.Accommodated further in the tip cover 560 is a freely extending andretracting casing 150 for receiving a detachable needle 561 attached tothe forceps member 115. The length of the tip cover 560 is adjusted sothat a tip of a detachable needle 561 is captured in a display of theendoscope 4 since the forceps members 115 and 131 are opened until thedetachable needle 561 is received. This provides the opening pair offorceps members 115 and 131, and the detachable needle 561 in a lowerportion of the displayed image 535 of the endoscope 4 as shown in, forexample, FIG. 37. This disposition permits the operator to observe thetrace of the detachable needle 561 in the image 535 until the pair offorceps members 115 and 131 close. The operator can conduct treatmentwhile continuously observing the detachable needle 561. Thus, thereliability of the treatment can be improved.

As shown in FIGS. 38, 40, and 42, the tip cover 560 is configured sothat a forceps-receiving section 571 having the forceps sheath 22connected thereto by means of, e.g., laser welding method and acartridge supporting member 572 having the hook sheath 21 connectedthereto by means of, e.g., laser welding method are connected in oneunit by a connection 573. Provided in the forceps-receiving section 571is a link mechanism 576 configured to include a rod 575 connected to theforceps operating wire 15. Connected to the distal end of the rod 575are a pair of link members 111 and 112 by means of a pin 110. The linkmember 111 is connected to a first forceps member by means of a pin 113.The first forceps member 115 extends from one pin-connected end sectionto the other end section having a curved needle 120 connected theretoand rotatively supported by the tip cover 560 via a pin 116. Attached onthe distal end of the curved needle 120 is a detachable needle 561.

The opposite end of the other link member 112 is rotatably connected tothe proximal end of an intermediate member 131A by means of a pin 130.The distal end of the intermediate member 131A is rotatably supported bythe tip cover 560 via a pin 132.

In the forceps member 131, a part 131C supported by the tip cover 560via the pin 132 is disposed inside the tip cover 560. The forceps member131 is urged by a charging spring 577 so that the tip part 131B of theforceps member 131 is fully closed when the forceps members 115 and 131are closed. The coiled charging spring 577 is slidably wound around thepin 132. An end 577A of the charging spring 577 makes contact with theopposite end 112A (see FIG. 40) of the link member 112 when the pair offorceps members 115 and 131 are closed. An opposite end of the chargingspring 577 comes into contact with the part 131C of the forceps member131. Since the charging spring 577 slidably and rotatively wound aroundthe pin 132 does not incline relative to the pin 132, it will not beremoved from the link member 112 and the forceps member 131.

As shown in FIG. 42, the end 577A of the charging spring 577 projectsfrom the tip cover 560 toward the tissue when the forceps members 115and 131 are opened. Since the approximately U-shaped bending portion ofthe end 577A is disposed toward the distal end, it will not stick thetissue when the distal end is pressed thereto.

Since the link members 111 and 112 each are longer than the distancebetween the rod 575 and the pins 116 and 132 as shown in FIG. 41, therod 575 cannot move further toward the distal end from this position.Therefore, the pin provided onto the rod and the guide hole provided onthe tip cover in accordance with the first embodiment will not benecessary. A guide hole may be provided onto only one end of the tipcover 560 for use in positioning the attaching device described inanother embodiment.

The curved needle 120 is inserted through a hole 115D having a circularcross section formed in the first forceps member 115 to be welded andfixed there. The cross sectional shape of the curved needle 120 is alsoan approximate circle, and both components are positioned by means of ajig that is not shown in the drawings. Machining man-hour can be reducedcompared with a conventional case where the positioning is conducted bycutting the cross section of the curved needle 120 in a C-letter shape.

A hook 581 is fixed to the distal end of the hook operating wire 18. Thehook 581 in a withdrawn state is put in the hook sheath 21. Greatersliding resistance between the hook 581 and the hook sheath 21 disturbsthe movement of the hook 581. Furthermore, if the sliding resistance isgreater, the greater sliding resistance damps the movement of the hook581 when the endoscope 4 is bent. The clearance between the hook 581 andthe hook sheath 21 is therefore increased so that the extending andretracting movement of the hook 581 can be provided by a moderate force.Incidentally, it is desirable that the clearance is greater than 0 mmand no greater than 0.1 mm. This range provides desirable movement ofthe hook 581. Therefore, the suture thread 125 will not be unhooked fromthe hook 581.

As shown in FIGS. 43 and 44, the hook 581 has an engaging section 582having a reduced width of its tip part section. The suture thread 125can be hooked by a barb 582A directed toward the proximal end of theengaging section 582 having a size capable of passing through the suturethread 125 toward the hook sheath 21. The engaging section 582 ismanufactured by a cutting operation using a tapered end mill. A proximalend portion is first cut diagonally with a portion of the cutting endmill that is approximately the same as the thread in diameter. A jaw 584is formed on the proximal end portion of the groove 583. The jaw 584 isdisposed offset from the axial line of the hook 581. Similarly, the barb582A of the engaging section 582 is disposed on the same side to theaxial line of the hook 581. Protruding the hook 581 from the coil sheath41 hooks the suture thread 125 at the jaw 584, thereby preventing thesuture thread 125 from detaching therefrom in a process of extending andretracting the hook 581. Also, the suture thread 125 is prevented fromdetaching the hook 581 by the jaw 584 when the coil sheath 41 is bent.The manufacturing of the hook 581 includes forming a groove 583 throughwhich the suture thread 125 is passed by using a significantly taperedcutting end mill, pressing the expanded-diameter section of the endmill, and forming a chamfering 585 for decreasing the width of the hook581. A one time machining operation for forming the groove 583 and thechamfering 585 reduces the cost for manufacturing the hook 581.

The hook 581 is manufactured by cutting a material having desirablemachinability, e.g., SUS420F2. This reduces the machining time andimproves the durability of the cutting tools.

As shown in FIG. 38, the hook sheath 21 is welded to a supporting member591 accommodated in a cartridge supporting member 372 of a tip cover 560in accordance with, e.g., a laser welding method. The supporting member591 has a projection for supporting the casing 150 at the distal end anda through-hole for passing through the hook 581. Further welded toengage the casing 150 are a pair of arms 592. The arms 592 made of anelongated flexible member are bent so that the distal ends pivot to openradially outward by a welded root section welded to the supportingmember 591. The tip part sections of the arms 592 are bent inward.Bending the welded arms 592 reduces the assembly time. Since the arms592 are welded to recesses of the supporting member 591, the outerdiameter of the portion of the supporting member 591 corresponding tothe welded arms 592 is approximately the same as the other portion.Therefore the arms 592 can make extending and retracting movementssmoothly relative to the cartridge supporting member 572.

The proximal end of the cartridge supporting member 572 is reduced indiameter so as to be able to contact the supporting member 591, and thecartridge supporting member 572 has from here an inner diameterapproximately equal to the outer diameter of the supporting member 591while expanding in the axial direction, and the inner diameter isfurther enlarged to open at the distal end. Since the spacer 601 isinserted from the distal end of an inner hole, the enlarged innerdiameter portion is partly formed. Elastic force of the pair of arms 592of the supporting member 591 recover and open at theinner-diameter-enlarged portion, and the engagement of the casing 150 tothe concave portion 202 is released. The arms 592 are closed at theportion where the spacer 601 is inserted, and the arms 592 make contactwith a concave portion 202 of the casing 150. The portion where thespacer 601 is inserted corresponds to a position where the curved needle120 is withdrawn from the casing 150 after the pair of forceps members115 and 131 are closed. Therefore, the arms 592 pressed and deformed bythe spacer 601 engage the casing 150; and the drop-off of the withdrawncurved needle 120 is thus prevented.

The pair of arms 592 are opened to be able to accommodate the attachedcasing 150 since the supporting member 591 is disposed toward theproximal end. Merely hooking the hook 581 at the loop 125A and drawingthe hook 581 completes attaching of the casing 150 to the tip cover 560.Time and effort for attaching the casing 150 are reduced.

As shown in FIG. 45, a cartridge (otherwise called a retaining device)153 is provided with the detachable needle 561, the suture thread 125crimped and fixed to the detachable needle 561, and the casing 150through which the suture thread 125 is passed. The detachable needle 561has an acute distal end and a proximal end having a slot 610 into whichthe curved needle 120 can be intruded. The dimension of the slot 610 isdetermined so that the detachable needle 561 can be supported or removedby appropriate force even if the inner diameter of the curved needle 120has dimensional error. For example, in a case where the detachableneedle 561 is 5 mm in total length, the slot 610 is approximately 1.4 mmin length reduces a spring constant, thereby restricting the deviationof the attaching and removing force with respect to the detachableneedle 561 and the curved needle 120. Although a contact part 611contacting the surface of the distal end of the curved needle 120 isdisposed to the detachable needle 561, the slot 610 is stopped at aregion closer to the proximal end relative to a position where thecontact part 611 is formed. The absence of the slot 610 in the partwhich is inserted into the curved needle 120 prevents the detachableneedle 561 from wobbling and facilitates the aligning of the axial lineof the curved needle 120 to the axial line of the detachable needle 561.

As shown in FIGS. 45 and 46, the proximal end of the detachable needle561 is cut in a plane orthogonal to a silt forming the slot 610, and thedetachable needle 561 is shortened in length in this direction. The endsurfaces 612 are cut to have a distance in between so that the curvedneedle 120 can be inserted in a case where the slot 610 is deformed evenif the hole in the curved needle 120 is the minimum of the designtolerance. Although the width in the direction that can be reduced bymeans of the slot 610 is longer than the distance between the endsurfaces 612, this direction can be flexibly modified in accordance witha hole diameter of the curved needle 120 by means of the slot 610.Partly cutting the end portion of the detachable needle 121 permits thedimensional error in the curved needle 120, thereby providing a reliablepress-fitting of the detachable needle 561 to the curved needle 120 withmoderate force.

As shown in FIG. 45, the suture thread 125 passing through the casing150 has one end fixed to the detachable needle 561 and the other endhaving a loop 125A based on the double, drawn-untied knot. The length ofthe suture thread 125 from the detachable needle 561 to the casing 150is approximately 35 mm, that is necessary and sufficient for binding atissue. The portion pulled from the casing 150 reaches the end of theloop 125A, and the length of the portion is approximately 10 mm. Thisreduces the stroke amount of the hook 581 between the projectingposition of the hook 581 and the binding position when the cartridge 153is attached. Optimizing the length of the suture thread 125 reduces themanipulation with regard to the stroke amount of the hook operatingportion 14, thereby facilitating the operation. Shortening the length ofthe pulled out portion of the casing 150 prevents the suture thread 125extruded from the casing 150 from being shaggy, thereby preventing thesuture thread 125 from clogging in the hook sheath 21.

The length of the end 125B of the suture thread 125 remaining afterforming the loop 125A is 2 mm or greater. This prevents the end 125B ofthe suture thread 125 from clogging or rubbing in the inner surface ofthe hook sheath 21 when the casing 150 is released. The extending andretracting movement of the casing 150 can be carried out smoothly.

As shown in FIGS. 38 and 45, the casing 150 has a two-piece structure.The member 621 accommodating a wire spring 165 thereinside can beengaged to a supporting member 591. A through-hole 623 that canaccommodate a proximal end section of the detachable needle 561 isformed to a member 622 directed toward the distal end. A wire spring 165having an approximate U-shape in plan view has ends 166 bentapproximately orthogonal to the insertion direction of the detachableneedle 561. The distance between the pair of bent ends 166 isapproximately the same as the outer diameter of the small-diameter part561A to which the detachable needle 561 is crimped and smaller than theouter diameter of the contact part 611 directed to the proximal end ofthe detachable needle 561. As shown in FIGS. 45 and 47, formed in themember 622 directed toward the distal end are the through-hole 623 and ahole 624 to which the wire spring 165 can be inserted. The approximateU-shaped portion of the wire spring 165 can be inserted through the hole624 having a planular shape. The pair of end portions 165A is deformedso as to be the outer diameter of the through-hole 623 or smaller, andthe wire spring 165 is then inserted into the holes 623 and 624. Sincethere is a spacer 625 which accommodates the spread end portions 165Abetween a distal end member 622 and a proximal end member 621, insertingthe wire spring 165 into the spacer 625 opens the end portions 165A,thereby subsequently preventing the removal of the wire spring 165. Whenthe detachable needle 561 is inserted, the pair of end portions 165A arepushed to spread at the distal end of the detachable needle 561. Thepair of end portions 165A recover and close at the small-diameter part561A of the detachable needle 561 into engagement to the detachableneedle 561. Since the end portions 165A of the wire spring 165 arehooked on a wall surface of the distal end member 622 in this state, thewire spring 165 locks the detachable needle 561 even if the detachableneedle 561 is pulled. Therefore, the detachable needle 561 will not beremoved from the casing 150. The configuration where the wire spring 165is inserted into the distal end permits an integral construction havingthe distal end member 621 of the casing 150 and the proximal end member622. The detachable needle 561 can therefore be accommodated reliably.

Conventionally, two components constituting the casing are integrated byusing an adhesion method or an ultrasonic welding method. In this case,if the welded section is detached and the distal end of the detachableneedle 561 is exposed therefrom, the exposed distal end may possiblycontact and damage the tissue. Since the casing 150 has a non-separated,i.e., integral structure in the present embodiment, the wire spring 165is puckered and inserted into an opening on the distal end that receivesthe detachable needle 561 during the assembly so that the undercutportion prevents the spread wire spring 165 from being removed.

The pair of forceps members 115 and 131 are closed and the curved needle120 is inserted into the tissue when the tissue is bound with thecartridge 153. As shown in FIG. 48, the detachable needle 561 directedto a manipulation side is disposed coaxially with the casing 150. Whenthe hook sheath 21 is manipulated to extend, the detachable needle 561is inserted into the casing 150 as shown in FIG. 49. Since a pair ofarms 392 pushed and closed by the spacer 601 then tightens the concaveportion 202, the spacer 601 will not be dropped off or the axis will notbe deviated. After the detachable needle 561 is locked by the wirespring 165, the hook sheath 21 is manipulated to be withdrawn. As shownin FIG. 50, the detachable needle 561 removed from the curved needle 120is drawn in the tip cover 560 together with the casing 150.

The pair of forceps members 115 and 131 are then opened to extend thehook sheath 21. As shown in FIG. 50, upon projecting the casing 150ahead of the tip cover 560, the hook operating portion 14 is manipulatedand pulled to retract the hook 581. The pulled suture thread 125constricts the tissue. The hook sheath 21 is retracted after binding thetissue, and the casing 150 is removed from the supporting member 591 byextending the hook 581. The hook 581 is projected from the supportingmember 591 to remove the suture thread 125 from the hook 581. Thecartridge 153 is retained while binding the tissue.

Third Embodiment

As shown in FIG. 52, provided to a scope holder 26 is a receivingportion 701 attached to an endoscope operation section 4A. A cut 702corresponding to a forceps plug section 4B is formed at the receivingportion 701 having an approximate C-letter shape in cross section.Before attaching the scope holder 26 to the endoscope 4, the receivingportion 701 is fit into the endoscope operation section 4A and fastenedby a binding band 703 disposed across a forceps plug section 4B. Alocking head section 705 is integrally disposed to one end of anelongated band section 704 of the binding band 703. A rack is disposedon the band section 704 along the longitudinal direction. The bindingband 703 is locked to two attaching sections 707 and 708 disposed acrossthe cut 702 of the receiving portion 701.

One of the attaching section 707 has an insertion portion 707A thatpermits the band section 704 to pass therethrough but does not pass thelocking head section 705; and a protrusion 707B for preventing the bandsection 704 from shifting. As shown in FIG. 53, provided to the otherattaching section 708 are a protrusion 708A for preventing the bandsection 704 from shifting; and an insertion portion 708B for passing theband section 704 therethrough. Furthermore, fixed to the insertionportion 708B is a locking section 708C having a ratchet claw engagingthe rack of the band section 704. The ratchet claw and the rack engagein the withdrawing direction of the band section 704 but not in theinsertion direction of the band section 704. The scope holder 26 can beattached to the endoscope 4 of an arbitrary type since the forceps plugsection 4B is fastened and fixed by the binding band 703. Also, thefastening, by means of the binding band 703, tightly fixes the sutureinstrument to the endoscope 4.

A modified example of the present embodiment will be explained asfollows. A scope holder 26 shown in FIG. 54 has an attaching member 710of a receiving portion 701 in construction. The attaching member 710 hasa locking section 708D. The locking section 708D is cut in a directionorthogonal to the insertion direction of the band section 704, and thusa ratchet claw 711 is exposed. When the scope holder 26 is attached tothe endoscope 4, the binding band 703 is inserted into a attachingsection 707, and the other end of the band section 704 is passed andpulled through the attaching section 708. When the scope holder 26 isdetached from the endoscope 4, the band section 704 having passedthrough the band section 704 is slid in a direction approximatelyorthogonal to the insertion direction indicated by an arrow shown inFIG. 53, and the band section 704 is extracted from the cut surface. Thebinding band 703 can be reused.

Also, a binding band 712 as shown in FIG. 55 may be used. A cut 713having an approximate V-letter shape is formed to an end portion of theband section 704 of the binding band 712. When the scope holder 26 isattached to the endoscope 4, the binding band 712 is inserted from theattaching section 707. As shown in FIG. 56, the cut 713 of the bandsection 704 is hooked at the insertion portion 707A. The other end ofthe band section 704 is passed and pulled through the attaching member710. When the scope holder 26 is detached from the endoscope 4, the bandsection 704 having passed through the locking section 708D is slid toextract the band section 704. Since the cut 513 is merely hooked to theattaching section 707, the binding band 712 can be detached withoutdifficulty. The binding band 712 can be reused.

Also, as shown in FIG. 57, an elastic deformable locking section 715 maybe disposed to integrally extend from an outer periphery of the cut 702of the receiving portion 701. Provided to the locking section 715 are aprojecting claw 715A for locking to the forceps plug section 4B; and anintegrally formed lever 715B for operating the unlocking of claw 715A.When the receiving portion 701 is attached to the endoscope 4, pressingthe lever 715B to deform the locking section 715, thereby opening theclaw 715A. After the receiving portion 701 in this state is attached tothe endoscope 4, the lever 715B is unclasped. The locking section 715recovers and locks the claw 715A to the forceps plug section 4B, therebythe scope holder 26 is fixed. One-touch lever operation enables thescope holder 26 to be attached to the endoscope 4. Incidentally, thelocking section 715 may be separate from the receiving portion 701.

Fourth Embodiment

As shown in FIG. 39 and FIG. 58, a valving element 721 for bundling thetwo coil sheaths 41 and 42, and the endoscope inserting part 5 of theendoscope 4 has a through-hole 722 having a larger diameter than that ofthe valving element 50 according to the first embodiment. Little contactbetween an inner circumference of the valving element 721 and theinserted endoscope inserting part 5 facilitates the insertion of theendoscope 4. Also, the diameter of a press-fit part 723 of the valvingelement 721 is smaller than that of the first embodiment. Even if apress-fit part 723 is crushed by the inserted endoscope 4, the reducedarea making contact with the endoscope 4 facilitates the insertion ofthe endoscope 4. This valving element 721 enhances the operability forinserting the endoscope 4.

Also, the diameter of the press-fit part 724 around the outercircumference of the valving element 721 is reduced in order to decreasethe sliding resistance subjected to the insertion of the valving element721 into the overtube 6. Even if a press-fit part 724 is crushed in theovertube 6, the reduced contacting area facilitates the insertion.Incidentally, these press-fit parts 724 are configured to have a sizewhere airtightness and slidability can be compatibly established.

The hardness of a rubber constituting the valving element 721 isdecreased from conventional 50° to, for example, 40° in order todecrease the sliding resistance subjected to the insertion of thevalving element 721 into the overtube 6. It is possible to decrease theforce required to insert the valving element 721 into the overtube 6 andreduce treating time and stress accompanying the operation.

Fifth Embodiment

FIG. 59 and FIG. 60 show a modification example of the cartridge. Also,FIG. 61 illustrates a hook used together with the cartridge.

A suture thread 125 is passed through a casing 150 of the cartridge 751,and a detachable needle 561 is attached to the suture thread 125. Thesuture thread 125 upon having passed through a brake portion 191 in ahole 190 of a proximal end member 621A is extracted, returned in theoutside of the casing 150, and reentered into the member 621A. Thus, aloop 125A of the suture thread 125. The end portion of the suture thread125 pulled into the casing 150 is crimped and fixed to the brake portion191 accommodated in the hole 190. A knot 126 formed there serves as aremoval stopper. The means for fixing the suture thread 125 may be acrimped structure or a knot 126.

Apparently two suture threads 125 are extending from the member 621A ofthe cartridge 751 since the loop 125A of the suture thread 125 extendsinto the member 621A.

Extending the hook 581A expels the suture thread 125 into a spacebetween the hook 581A and a sheath 21, thereby extending only the hook581A since the hook 581A shown in FIG. 61 does not have an overhangshape, i.e., the proximal end through which the suture thread 125 ispassed does not expand toward the distal end. Extending the hook 581Afurther into contact with the brake portion 191 reliably separates thecasing 150. Incidentally, when a tissue is bound, the hook 581A isretracted as shown in FIG. 62. The loop 125A of the suture thread 125hooked on the hook 581A provides constriction of the suture thread 125.

The use of the hook 581A facilitates to push the casing 150, therebyreliably extruding the casing 150.

Although a space 190A that can accommodate the knot 126 is disposed onan axial line of the hole 190 of the casing 150 in the example shown inFIG. 59A, the space 190A directed toward the distal end may be omitted.In this case, the knot 126 is returned to the manipulation side to beaccommodated in the hole 190 as shown in FIG. 59B.

Sixth Embodiment

FIG. 63 illustrates a treatment section 807 in a cross sectional view ofa suture instrument 801 (applicator) as an endoscopic treatmentinstrument. Incidentally, the structure for holding the casing 150 maybe that of the second embodiment.

As shown in FIGS. 63 and 64, provided to the treatment section 807 are afirst finger-hook ring 811 for rotating a forceps member 115 as a firstforceps member in a tip cover 810; and a second finger-hook ring 812 forrotating the forceps member 131 as a second forceps member.

A freely extending and retractable connection rod 822 is connected to alink member 111 of the first finger-hook ring 811 via a pin 821. Theconnection rod 822 extending in parallel with a rod 100 as an inputtingmember is supported by a tip cover 810. The proximal end portion of theconnection rod 822 is a first connecting portion 823 through which theconnection rod 822 is passed. Two control plates 824A and 824B aredisposed alternately with respect to an extending and retractingdirection of the rod 100 in the first connecting portion 823. Thesefreely inclinating control plates 824A and 824B each are inserted intotwo slits 825 disposed in the first connecting portion 823. The controlplates 824A and 824B each have one hole 826 through which a rod 100 isinserted. A coiled spring 827 disposed along the rod 100 to compress theinclined control plates 824A and 824B allows end portions of the platesdirected toward the slit 825 to access each other while the other endportions are separate from each other. The hole 826 is configured insize so that the inclined control plates 824A and 824B engage the rod100 and control plates 824A and 824B standing orthogonal to the axialline form a clearance relative to the rod 100. The distal end controlplate 824A projects through the slit 828 into the opposite end.

A freely extending and retractable connection rod 832 is connected to alink member 112 of the second finger-hook ring 812 via a pin 831. Theconnection rod 832 is supported by the tip cover 810 in parallel withthe rod 100 opposite to the first finger-hook ring 811 relative to therod 100. The distal end portion of the connection rod 832 relative tothe first connecting portion 823 of the first finger-hook ring 811 formsa second connecting portion 833. The freely extending and retractablerod 100 is passed through the second connecting portion 833, and twocontrol plates 834A and 834B are alternately disposed thereinside withrespect to the extending and retracting direction of the rod 100. Thecontrol plates 834A and 834B directed toward the distal end are insertedat a rotated direction of 90° around the axial line relative to thecontrol plates 824A and 824B of the first finger-hook ring 811. Thecontrol plate 834A capable of freely inclining is passed through a slit,not shown in the drawing, formed in the second connecting portion 833.The control plate 834B is inserted at a rotated direction of 180° aroundthe axial line relative to the control plates 824A and 824B. The controlplate 834B capable of freely inclining is passed through a slit 835 ofthe second connecting portion 833. The rod 100 inserted through the hole836 formed in the control plates 834A and 834B each has a coiled spring837 disposed along thereof. Thus, the control plates 834A and 834B areurged to separate from each other. The hole 836 is configured in size sothat the inclined control plates 834A and 834B engage the rod 100 andcontrol plates 834A and 834B standing orthogonal to the axial line forma clearance relative to the rod 100. The distal end control plate 834Aprojects through the slit 838 into the opposite end.

In addition, an approximately parallel lock arm 841 is disposed closerto the hook sheath 21 relative to the rod 100. The freely swinging lockarm 841 is supported by the tip cover 810 via a pin 132 inserted throughan elongated hole 842. The lock arm 841 has a protrusion 843 capable ofengaging the distal end of the second connecting portion 833 of theconnection rod 832 and a rack 844 capable of engaging the control plate834A so that a barb of the end portion of the rack 844 projects towardthe rod 100. The lock arm 841 is urged by a pressure spring 845 betweenthe elongated hole 842 and the protrusion 843 so that the distal end isdirected toward the rod 100.

Incidentally provided to the tip cover 810 is an abutment section 851that allows the control plate 834A to make contact with the distal endof the second connecting portion 833. An abutment section 852 to whichthe projecting portion 822A of the connection rod 822 pressed by thecontrol plate 834B can make contact is provided and is directed to theproximal end relative to the control plate 834B as shown in FIG. 63illustrating an initial position. Provided further in the vicinity ofthe distal end of the rod 100 is a abutment section 853 capable ofmaking contact with the control plate 824B. Provided in addition is aground portion 854, onto which the lock arm 841 overrides, forpermitting a space between the control plate 824A and the lock arm 841.

The operation of the suture instrument 801 will be explained.

When the opening state of a pair of forceps members 115 and 131 isclosed, the rod 100 is retracted. The links 811 and 812 each areconnected to the rod 100 by inclining the control plates 824B and 834Bdirected to the proximal end. The pair of forceps members 115 and 131are therefore rotated in the closing direction in accordance with theretracting rod 100 as shown in FIG. 65. Retracting the connection rod822 of the second finger-hook ring 812 disengages the protrusion 843from the connection rod 822. The proximal end of the lock arm 841directed to the proximal end of the suture instrument 801 is rotatedtoward the rod 100 urged by the pressure spring 845. However, the lockarm 841 rotated by the urging force of the lock arm 841 does not engagethe control plate 824A moving in the direction corresponding to theclearance angle of the rack 844 of the lock arm 841.

The rotation of the pair of forceps members 115 and 131 by a degree of90° relative to the initial state shown in FIG. 66 allows the controlplate 834B of the second finger-hook ring 812 to make contact with theabutment section 852 of the tip cover 810. The control plate 834B pushedby the abutment section 852 is returned to an approximately verticaldirection while resisting the coiled spring 837. The connection betweenthe second finger-hook ring 812 and the rod 100 is released. As shown inFIG. 67, pulling further the rod 100 rotates only the forceps member 115while the forceps member 131 connected to the rod 100 does not rotate.

As shown in FIG. 68, closing the forceps members 115 and 131 allows thecontrol plate 824B of the first finger-hook ring 811 to make contactwith the abutment section 853. The control plate 824B pushed by theabutment section 853 is returned to an approximately vertical directionwhile resisting the coiled spring 827. That results in the disconnectionbetween the second finger-hook ring 811 and the rod 100. This positionis equivalent to the most withdrawn position of the rod 100. Even if thelock arm 841 is disposed on the ground portion 854 and the controlplates 824A and 824B moves, uninterfered state with the ratchet claw 844is maintained since the lock arm 841 hooked on the control plates 824Aand 824B moves in the withdrawing direction of the rod 100.

Extending the rod 100 from the closed state of the pair of forcepsmembers 115 and 131 connects the second finger-hook ring 812 to the rod100 due to the connection between the distal end control plate 834A andthe rod 100, thereby opening the forceps member 131. The lock arm 841,while riding on the connection rod 822 and pushed, moves toward thedistal end immediately before the forceps member 131 fully opens. Theforceps member 115 opens since the first finger-hook ring 811 issimultaneously in conjunction with the rod 100 due to the engagementbetween the rod 100 and the distal end control plate 824A inclined bythe lock arm 841. As shown in FIG. 69, the control plate 834A makingcontact with the distal end abutment section 851 where the rotatedforceps member 131 by an angle of 90° opens resists the coiled spring837, and is pushed back approximately orthogonally. The forceps member131 therefore does not move afterward if the rod 100 is extended. Theforceps member 115 opens by approximately 180° beyond 90° due to theengaged state of the first finger-hook ring 811.

Pushing back the rod 100 halfway from the position shown in FIG. 67permits the forceps members 115 and 131 to open in turn. As shown inFIG. 65, the rack 844 of the lock arm 841 engaging the control plate824A of the first finger-hook ring 811 disposes the control plate 824Avertically. That results in the disconnection between the secondfinger-hook ring 811 and the rod 100. The forceps member 115 does notopen while only the forceps member 131 opens. As shown in FIG. 71, thecontrol plate 834A making contact with the abutment section 851 when theforceps member 131 opens by 90° disconnects the second finger-hook ring812 from the rod 100.

In the present embodiment, two connecting portions 823 and 833 aredetachably connected to one rod 100, and each connecting portions havepoints for connecting and disconnecting in the extending and retractingdirection of the rod 100; thus, the forceps members 115 and 131 arerotatable independently. Therefore, it is possible to regrip the tissue,reinsert the needle, and grip an intended tissue reliably.

The variations of the opening and closing operation of the pair offorceps members 115 and 131 will be explained with reference to FIGS. 72to 75. In the drawings, the abscissas indicate time, and the ordinatesindicate a rotational angle of the forceps members 115 and 131 from theopen state. Lines S1 indicate a trace of changing strokes of the rod100, and the larger numbers indicate a more significant retraction.Lines S2 indicate the trace of rotational angle of the forceps member115 based on the strokes of the rod 100. Lines S3 indicate the trace ofrotational angle of the forceps member 131 based on the strokes of therod 100. The rotational angle of 0° on the lines S2 and S3 indicates thefully open position of the forceps members 115 and 131.

As described by the line S1 in FIG. 72, the rod 100 is moved from themost extended position to the most retracted position, and then extendedagain. As described by the line S2, the forceps member 115 is movedcontinuously in conjunction with the rod 100. As described by the lineS3, the forceps member 131 does not rotate by rotational angles of 90°or greater.

As shown in FIG. 73, the rod 100 is extended after the rod 100 isretracted from the most extended position and the pair of forcepsmembers 115 and 131 closes. When the rod 100 is extended, the forcepsmember 115 stops and the forceps member 131 opens corresponding to therod 100. Pulling the rod 100 afterward rotates the pair of forcepsmembers 115 and 131 together in the closing direction, thereby eachstopping at 180° and 90°.

As shown in FIG. 74, the rod 100 is extended after the rod 100 isretracted from the most extended position and the forceps member 115rotates beyond 90°, i.e., by 135°. Along with the movement of the rod100, the forceps member 131 opens and the forceps member 115 stops.Retracting the rod 100 again closes the pair of forceps members 115 and131.

As shown in FIG. 75, the moving direction of the rod 100 is switchedinto extending direction before the rod 100 retracted from the mostextended position reaches the angle of 90°. Along with the movement ofthe rod 100, the forceps member 131 opens and the forceps member 115stops. Retracting the rod 100 again closes the pair of forceps members115 and 131.

The operation corresponding to FIG. 73 describing the examples for theabove operations will be more specifically shown in FIGS. As shown inFIG. 76, the curved needle 120 attached to one of the forceps members115 begin to be inserted into the tissue directed to one side of aninjury section T1. As illustrated in FIG. 77, one side of the tissue ofan injury section T1 is retrieved and gripped by the pair of forcepsmembers 115 and 131, and the curved needle 120 is inserted into thetissue. Moving this state of the rod 100 toward the distal enddisengages the rod 100 from the link for rotating the forceps member115, thereby opening only the forceps member 131. As illustrated in FIG.78, although the forceps member 131 opens, the curved needle 120 remainsbeing inserted through the tissue. Moving the suture instrument 801 asillustrated in FIG. 79 allows the forceps member 131 to bite the tissueopposite the injury section T1. Moving the rod 100 toward the proximalend closes the forceps member 131 while the forceps member 115 directedto the curved needle 120 remains stopped. As illustrated in FIG. 80, thecurved needle 120 is penetrated into the tissue retrieved by the forcepsmember 131. The rod 100 further extending as illustrated in FIG. 81 isconnected to a link of the forceps member 115; thus, the pair of forcepsmembers 115 and 131 closes.

In the cases described in FIGS. 73 and 75, the forceps member 131 havingthe smaller rotational range can be rotated while the forceps member 115having the greater rotational range is stopped at the rotated angle of90°. This is effective for reinserting the curved needle 120. When therod 100 is moved so as to open the pair of forceps members 115 and 131as described with respect to timings 3 to 5 of FIG. 73 and timings 4 to7 of FIG. 75, the forceps member 115 having the greater rotational rangeis stopped until the forceps member 131 having the smaller rotationalrange is fully opened.

In the cases described in FIGS. 73 and 75, the forceps member 131 havingthe smaller rotational range can be opened while the forceps member 115having the greater rotational range is stopped at the rotated angle of90°. Since the forceps member 131 grips the tissue with a force urged bythe charging spring 577, the forceps member 115 may open prior toopening the forceps member 131 when the pair of forceps members 115 and131 is opened; thus, the curved needle 120 may be removed. In such acase, the forceps member 131 can be opened while the forceps member 115is penetrated in the tissue. Enabling the pair of forceps members 115and 131 to operate independently by means of the rod 100 allows theforceps member 115 to once penetrate the tissue to open only by theforceps member 131 in the penetrated state, thereby allowing the pair offorceps members 115 and 131 to regrip and re-penetrate the previoustissue and another tissue. This configuration also allows the needle tobe intentionally moved to a desired position.

Seventh Embodiment

Provided in a attaching device 901 illustrated in FIGS. 82 and 83 aretwo base plates 902 and 903 that are pasted, and a cartridge 153accommodated therebetween. The attaching device 901 has an elongatedthread holding section 911 and a casing holding portion 912 so that thethread holding section 911 is connected to the casing holding portion912 via an arm 913. A suture instrument is attached to the attachingdevice 901 in use in the direction indicated by an arrow shown in FIG.82.

A pair of locking members 921 and 922 freely opening and closing isattached to the casing holding portion 912. Protrusions 921A and 922 Aare formed on ends of the locking members 921 and 922. The protrusions921A and 922A are inserted into the guide hole 80C on the tip cover 80of the suture instrument. In a case where the guide hole 80C is formedon only one side, the protrusion is formed on only one of the lockingmembers 921 and 922 correspondingly.

As illustrated in FIGS. 84 and 85, the plate 931 forming the threadholding section 911 is expanded approximately along the direction of theinsertion of the suture instrument indicated in the drawings. Disposedto project from the end portion is a enclosure section 932 capable ofreceiving the curved needle 120. In order to facilitate the reception ofthe curved needle 120, the opening width of the enclosure section 932increases gradually. A detachable needle 561 is accommodated in the backof the enclosure section 932. Formed in the enclosure section 932 is acut 932A for drawing the suture thread 125. A stay 933 for elasticallysupporting the detachable needle 561 is disposed on the plate 931orthogonally to the detachable needle 561. The detachable needle 561 isfurther supported by a thread holder 935 attached to the plate 931. Thethread holder 935 capable of accepting the curved needle 120 andcantilevered by a cantilever section 935A supports the curved needle 120with the detachable needle 561 aligned.

The plate 940 for integrally forming the arm 913 extends in thedirection orthogonal to the plate 931 at the end portion of the plate931. Connected integrally to the end portion of the plate 940 is a plate941 for forming the casing holding portion 912.

A sliding groove 943 is formed on the plate 941 in the direction of thearrow. Disposed in the sliding groove 943 is a holder 942 foraccommodating the casing 150. An engagement groove 944 is disposed inthe middle of the sliding groove 943 so as to project thereon in thedirection approximately orthogonal to the longitudinal direction of thesliding groove 943. Extended from the plate 941 are a guide piece 945Afor guiding the suture instrument 1 and an arm 946 for elasticallypressing the forceps member 131. A freely rotative locking member 922 issupported by a shaft 947 disposed in the approximate center. Guidepieces 931A, 931B, and 941B are disposed upright in the end portions ofthe plates 931 and 941 that extend in parallel.

The base plate 902 has a plate 948 constituting the thread holdingsection 911, a plate 949 constituting the casing holding portion 912,and a plate 950 constituting the arm 913. The configuration of the innersurface of the base plate 902 is approximately the same as that of thebase plate 903. However, the stay 933 is not disposed on the base plate902. Also, a groove slidably accepting the guide pieces 931A and 931B isdisposed on the base plate 903, and a groove slidably accepting theguide piece 941A is formed on the plate 948.

As illustrated in FIG. 86, a cylinder 952 of the holder 942 is rotatablyinserted into a main body section 951 capable of accommodating thecasing 150.

The casing 150 is inserted into the main body section 951 of the holder942. The casing 150 of the main body section 951 is locked by a pair ofelastically deformable arms 953, and a part of the proximal end of thecasing 150 is exposed to the outside of the holder 942. Provided aroundthe outer periphery of the main body section 951 is a flange-likeprojecting section 951A to which the bumped projecting section 951A isattached.

As illustrated in FIGS. 86 and 87, an arched part of the thread holder955 having an approximate C-letter cross section is depressedcorresponding to the cylinder 952. Formed from the arched curved surface955 a to the inner circumference surface is a groove 956 through whichthe suture thread 125 is passed. Also, a guide section 957 extendingapproximately along the casing 150 is disposed opposite to the curvedsurface 955 a with respect to a central axis. The suture thread 125 iswound on a shoulder section 957A at an outer periphery of the guidesection 957.

As illustrated in FIGS. 86 and 88, the suture thread 125 drawn from thecasing 150 is wound once on the outer periphery of the casing 150. Theloop 125A having been wound around the shoulder section 957A of theguide section 957 of the thread holder 955 is passed through the groove956 and wound around the cylinder 952. Formed halfway of the loop 125Ais a knot 125C hooked on the cylinder 952.

A groove 961 is formed toward the center of the cylinder 952. Althoughthe groove 961 permits one suture thread 125 to pass through, the widthof the groove 961 does not allow the knot 125C to pass therethrough. Theaxially rotative cylinder 952 is urged by a torsion coil spring, notshown in the drawing, accommodated in the main body section 951. Asillustrated in FIG. 86, a part of the cylinder 952 projects from an endportion of the main body section 951, and a stopper 962 bulging radiallyoutward is disposed to the projecting portion 952A. The stopper 962 isinserted into a engagement groove 944 directed to a base plate 902.

The holder 942 is smaller in length than the sliding groove 943 of thebase plate 902. Disposed across the end portion directed to the arm 913and the holder 942 is a coiled spring 965, and the holder 942 iscontinuously urged toward the plate 940. However, the holder 942 cannotbe pulled toward the plate 940 since the initial state of thethrough-hole 33 is locked by the engagement groove 944.

As illustrated in FIGS. 10, 38, 88, and 89, when the cartridge 153 isattached, the hook sheath 21 is extended while the open state of thepair of forceps members 115 and 131, a tip claw section 211 in thecartridge supporting member 86 is projected at the distal end.

As illustrated in FIGS. 90 and 91, pushing the treatment section 7 tothe attaching device 901 allows the protrusions 921A and 922A of thelocking members 921 and 922 to fit in the guide hole 80C of the tipcover 80 of the suture instrument 1.

In this state, the curved needle 120 of the forceps member 115 entersthe enclosure section 932 of the thread holding section 911. The curvedneedle 120 following the taper of the enclosure section 932 is guided tothe detachable needle 561 even if there is a positional deviationbetween the curved needle 120 and the enclosure section 932 since theenclosure section 932 is a circular truncated cone in a shape where thediameter of the opening decreases more significantly inward of theopening. The curved needle 120 begins to fit in the detachable needle561 aligned by the thread holder 935 while wedging the thread holder 935aside. The thread holder 935 wedged aside by the curved needle 120 movesbeyond the stay 933 at a supporting point of the cantilever section 935Aover the stay 933 and evacuates from the moving path of the curvedneedle 120. In this state, the distal end of the stay 933 making contactwith the thread holder 935 retains the thread holder 935 so that thethread holder 935 does not return to the detachable needle 561.

Since the detachable needle 561 is supported in the vicinity of theopening of the enclosure section 932, the curved needle 120 is fit intothere while pushing the detachable needle 561. Although the threadholding section 911 is freely movable relative to the casing holdingportion 912 due to the elastic deformation of the arm 913, since theguide pieces 931A, 931B, and 941A are slidable only along the groove inthe vicinity of the base plate 902, the moving direction of the threadholding section 911 is regulated in the insertion direction of thesuture instrument 1. Therefore, the axial line of the distal end of thecurved needle 120 does not deviate from the axial line of the detachableneedle 561; thus, reliable placement can be obtained.

On the other hand, the forceps member 131 makes contact with the arm 946of the casing holding portion 912. The forceps member 131 is urged intothe opening direction by the arm 946. This enforces the pair of forcepsmembers 115 and 131 to open in state suitable for attaching thecartridge 153 even if the forceps member 131 has a clearance or amanufacture error.

As illustrated in FIG. 92, extending the hook 212 thrusts the casing 150into the holder 942. Since the fully thrusted casing 150 provides anexcess of the loop 125A of the suture thread 125 wound around the outerperiphery of the casing 150, the cylinder 952 is rotated by means of thetorsion coil spring around the main body section 951. Winding the loop125A around the cylinder 952 pulls the suture thread 125, therebywinding around the hook 212.

Drawing back the hook 212 attracts the thread holder 955 to the sutureinstrument 1 because the suture thread 125 is hooked on the groove 961.A stopper 962 of the holder 942 is hooked on the engagement groove 944and urged oppositely by the coiled spring 965. Therefore, as illustratedin FIG. 93, only the thread holder 955 moves. The suture thread 125drawn by the thread holder 955 is removed from the cylinder 952.

Disengagement of the suture thread 125 rotates the cylinder 952 further,and the stopper 962 disposed from the main body section 951 to theprojecting section 952A is removed from the engagement groove 944. Asillustrated in FIG. 94, a coiled spring 965 is contracted, and theholder 942 moves along the sliding groove 943. Since the hook 212 isunmovable, tension is provided to the suture thread 125 wound around thehook 212. As illustrated in FIG. 95, drawing back the hook 212 attractsthe thread holder 942 via the suture thread 125. Force drawing the hook212 and drawing force of the coiled spring 965 act on the arm 953 (seeFIG. 86) of the holder 942. Drawing the hook 212 by a predeterminedlength attracts the casing 150 into the cartridge supporting member 86,thereby moving the holder 942 together with the casing 150 toward thesuture instrument 1. Since this position has a space for evacuation ofthe arm 953, the arm 953 is disengaged from the casing 150 separatingfrom the holder 942 and accommodated in the cartridge supporting member86. Placement of the cartridge 153 is completed by opening the lockingmembers 921 and 922 to retract the suture instrument 1 as illustrated inFIG. 96 separate from the attaching device 901.

The attaching device 901 in use in the present embodiment facilitatesthe placement of the cartridge 153. Also, the attaching device 901 candraw back the tensioned suture thread 125 wound around the hook 212 intothe suture instrument 1 since the holder 942 is drawn back by the forceurged by the coiled spring 965 after winding the suture thread 125around the hook 212. The reliable placement of the cartridge 153 can betherefore obtained since the suture thread 125 will not be disengagedfrom the hook 212. In addition, the attaching device 901 can be used inthe suture instrument 501.

Eighth Embodiment

Provided in an attaching device 1001 illustrated in FIG. 97 are two baseplates 1002 and 1003 that are pasted, and a cartridge 153 accommodatedtherebetween. As illustrated in FIG. 98, formed in the attaching device1001 is a groove 1009 in which a freely extending and retractable rod1010 is accommodated in the longitudinal direction. A locking member1071 is fixed on the distal end of the rod 1010, and the locking member1071 is inserted into the casing 150 to be fixed thereon. A rubber shaftallowing the casing 150 to be moderately press-fit renders the lockingmember 1071 easy-to-remove. A coiled spring 1012 is wound around theouter periphery of the rod 1010. One end of the coiled spring 1012 islocked to an end of the groove 1009. The other end of the coiled spring1012 is fixed to the rod 1010. The rod 1010 is locked by a protrusion1015 at a position where the coiled spring 1012 is pressed by apredetermined length. The rod 1010 is therefore urged in a directionindicated by an arrow shown in FIG. 98 in accordance with the pressureprovided to the coiled spring 1012. The protrusion 1015 is disposed toproject from a button 1014 integrally formed with the base plate 1002.The button 1014 can be pressed in a direction orthogonal to the surfaceof the base plate 1002, and if the button 1014 is pressed, theprotrusion 1015 moves in the same direction.

A receiving portion 1016 is further provided to the base plate 1002. Thewidth of the opening end of the receiving portion 1016 is enlarged so asto be able to align and support the detachable needle 561 andaccommodate the curved needle 120. An arm 1017 is disposed to projectfrom the edge section of the base plate 1002 opposite the receivingportion 1016.

In addition, the base plate 1003 has approximately the sameconfiguration as that of the base plate 1002 except that the base plate1003 does not have the protrusion 1013 and the button 1014.

As illustrated in FIG. 99, fitting the casing 150 of the cartridge 153to the locking member 1071 allows the rod 1010 to support the casing150. The detachable needle 561 is attached to the receiving portion1016. The suture thread 125 is routed through a space between the baseplates 1002 and 1003.

When the cartridge 153 is attached to the suture instrument 1, a loop125A is hooked on a hook 212, and then a button 1014 is pressed. Asillustrated in FIG. 100, the protrusion 1015 is disengaged from the rod1010, and the rod 1010 moves in a direction separating from the sutureinstrument 1. The withdrawn state of the suture thread 125 providestension between the hook 212 and the loop 125A. The force exerted by thecoiled spring 1012 does not disengage the loop 125A from the hook 212.The curved needle 120 entering the receiving portion 1016 fits thedetachable needle 561. The forceps member 131 making contact with thepressing arm 1017 allows the pair of forceps members 115 and 131 tofully open.

Depressing the hook 212 attracts the rod 1010 via the suture thread 125and the casing 150. As illustrated in FIG. 101, pressing the coiledspring 1012 projects the rod 1010, thereby withdrawing the casing 150into the casing holding portion in the tip cover 80. Afterward,separating the suture instrument 1 disengages the casing 150 from thelocking member 1011, thereby passing the cartridge 153 to the sutureinstrument 1.

The use of the flexible member, e.g., a spring that spontaneouslyretracts the hook 212 eliminates the need for withdrawing thefinger-hook ring 17 in the vicinity of the proximal end of the controlportion 2. As illustrated in FIG. 102, the spring 1022 is disposed on anouter periphery of the reinforcement pipe 1021 covering the hookoperating wire 18 with the control portion 2, and the hook operatingportion 14 is urged in a direction toward the proximal end. Theconfiguration of control portion 2 facilitates operation in the casewhere the cartridge 153 is attached without using the attaching device1001 described in the embodiments.

In the present embodiment, since tension utilizing the force exerted bythe coiled spring 1012 is provided to the loop 125A first hooked on thehook 212, the cartridge 153 can be reliably attached to the sutureinstrument 1 without disengaging the loop 125A from the hook 212.Operation with a rubber grove is still easy since the tension can beprovided by button operation.

FIG. 103 illustrates a modified example. The freely extending andretractable rod 1010 is disposed in the attaching device 1101. When thecartridge 153 is attached to the suture instrument 1, a loop 125A ishooked on a hook 212, and then a button 212 is brought back. The slidingresistance of the rod 1010 provides tension to the suture thread 125.The attaching device 1101 having a simple configuration allows thecartridge 153 to be attached to the suture instrument 1.

Although the preferred embodiments have been described as above, thepresent invention is not limited to these. For example, the presentinvention can be applied to a rigid endoscope having a rigid insertionportion although a description has been given of a use for the flexibleendoscope having the flexible insertion portion in the aboveembodiments. An arbitrary combination of the components described ineach embodiment is also effective in use. Also, methods that can be usedfor attaching the previously described components are laser-welding,brazing, soldering, adhesion, press-fitting, crimping, and anycombination of these methods. Also a two-component part may bemanufactured integrally by methods, e.g., pressure-welding or molding.The configuration of the present invention allows for addition,omission, substitution and further replacement without departing fromthe spirit and scope of the present invention. The present invention isnot limited to the above descriptions but is limited only by theappended claims.

1. An endoscopic treatment instrument comprising: an insertion portioncomprising a distal end and a proximal end, the distal end being adaptedto be inserted into a human body; a treatment portion disposed to thedistal end; and a control portion disposed to the proximal end, whereinthe treatment portion comprises: an extendable and retractable inputmember operated by the control portion; a first link disconnectablyconnected to the input member through a first connecting portion; afirst control plate disposed in the first connecting portion, the inputmember inserted through the first control plate, and the first controlplate being configured to engage the input member by inclination of thefirst control plate; a first forceps member capable of opening andclosing according to advancing and retracting motions of the first link;a second link disconnectably connected to the input member through asecond connecting portion; a second control plate disposed in the secondconnecting portion, the input member inserted through the second controlplate, and the second control plate being configured to engage the inputmember by inclination of the second control plate; and a second forcepsmember capable of opening and closing according to advancing andretracting motions of the second link, and having an opening-and-closingangle which is lower than an opening and closing angle of the firstforceps member, wherein the second connecting portion makes theconnection between the input member and the second link according to aninclination motion of the second control plate until the second forcepsmember is opened by a predetermined degree of opening.
 2. The endoscopictreatment instrument according to claim 1, further comprising: anabutment section provided with the treatment instrument and adapted tocontact a distal end of the second control plate when the input memberis extended, and the second connecting portion that has the secondcontrol plate having one hole through which the input member isinserted, wherein when the second control plate contacts the abutmentsection, the second control plate stands vertically, and the secondconnecting portion connects the input member to the second link, by thehole providing engagement between the second control plate and the inputmember when the second control plate is disposed diagonally with respectto the moving direction of the input member, until the input member isretracted a predetermined length.
 3. The endoscopic treatment instrumentaccording to claim 1, further comprising: an abutment section providedwith the treatment instrument and adapted to contact a distal end of thesecond control plate when the input member is extended, and the secondconnecting portion that has the second control plate having one holethrough which the input member is inserted, wherein when a distal end ofthe second control plate contacts the abutment section, the secondcontrol plate stands vertically, and the second connection portion makesthe connection between the input member and the second link due to theinput member connecting the second link by the hole providing engagementbetween the second control plate and the input member when the secondcontrol plate is disposed diagonally with respect to the movingdirection of the input member.
 4. An endoscopic treatment instrumentcomprising: an insertion portion comprising a distal end and a proximalend, the distal end being adapted to be inserted into a human body; atreatment portion disposed to the distal end; and a control portiondisposed to the proximal end, wherein the treatment portion comprises:an extendable and retractable input member operated by the controlportion; a first link disconnectably connected to the input memberthrough a first connecting portion; a first control plate disposed inthe first connecting portion, the input member inserted through thefirst control plate, and the first control plate being configured toengage the input member by inclination of the first control plate; afirst forceps member capable of opening and closing according toadvancing and retracting motions of the first link; a second linkdisconnectably connected to the input member through a second connectingportion; a second control plate disposed in the second connectingportion, the input member inserted through the second control plate, andthe second control plate being configured to engage the input member byinclination of the second control plate; and a second forceps membercapable of opening and closing according to advancing and retractingmotions of the second link, and having an opening-and-closing anglewhich is lower than an opening and closing angle of the first forcepsmember, and the second connection portion releases the connectionbetween the input member and the second link after the input member isretracted by a predetermined length in the direction of closing a fullyopen second forceps member.
 5. An endoscopic treatment instrumentcomprising: an insertion portion comprising a distal end and a proximalend, the distal end being adapted to be inserted into a human body; atreatment portion disposed to the distal end; and a control portiondisposed to the proximal end, wherein the treatment portion comprises:an extendable and retractable input member operated by the controlportion; a first link disconnectably connected to the input memberthrough a first connecting portion; a first control plate disposed inthe first connecting portion, the input member inserted through thefirst control plate, and the first control plate being configured toengage the input member by inclination of the first control plate; afirst forceps member capable of opening and closing according toadvancing and retracting motions of the first link; a second linkdisconnectably connected to the input member through a second connectingportion; and a second control plate disposed in the second connectingportion, the input member inserted through the second control plate, andthe second control plate being configured to engage the input member byinclination of the second control plate; a second forceps member capableof opening and closing according to advancing and retracting motions ofthe second link, and having an opening-and-closing angle which is lowerthan an opening and closing angle of the first forceps member, whereinthe second connection portion releases the connection between the inputmember and the second link when the second forceps member is fully open.6. The endoscopic treatment instrument according to one of claims 4 and5, wherein the first and second connection portions each has a pluralityof control plates each having one hole through which the input member isinserted, the hole provides engagement between the control plate and theinput member when the control plate is disposed diagonally with respectto the moving direction of the input member, and the connection betweenthe first and second connection portions and the input member isintermittently maintained by controlling the inclination of the controlplates.
 7. The endoscopic treatment instrument according to claim 6,wherein the plurality of control plates are urged in different diagonaldirections.